Covered Entity Details

RWIID70112 STD/HIV Program (Active) - information as of 4/29/2025 10:30:32 PM

Main Details

Name

STD/HIV Program

Subdivision Name

OFFICE OF PUBLIC HEALTH

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID70112

Grant Number

X07HA00018

Additional Details

Current Program Status

Active

Registration Date

7/1/1998

Participating Start Date

7/1/1998

Participating Approval Date

6/9/2005

Last Recertification Date

2/14/2025

Time Period the Assistance was Received

4/1/2022 - 3/31/2027

Contacts

Authorizing Official

Louisiana Office of Public Health
Samuel Burgess, STD/HIV/Hepatitis Program Director
(504) 568-7474

Primary Contact

Lousiaiana Office of Public Health STD/HIV Program
Matthew Arnold, LDAP Coordinator
(504) 568-7474

Addresses

Street Address

1450 POYDRAS ST.
Suite 2136
NEW ORLEANS, LA 70112

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
5/16/11 UPDATED ZIP (WAS 70113); 4/19/11 PHYS ADDR CHANGE (WAS 1010 COMMON ST, 11TH FLOOR)4/17/06 ADDR CHANGE (WAS 234 LOYOLA AVENUE, 5TH FLOOR), 3/22/06 NEW 340B ID # (WAS RW701121), ADDR CHANGE (WAS 325 LOYOLA AVE., 2ND FLOOR)	05/16/2011

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AFFORDABLE PHARMACY	1718 NORTH FOSTER DR		BATON ROUGE	LA	70806	01/13/2014	04/01/2014	12/31/2018	03/02/2020
Contract Detail	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	03/01/2013	04/01/2013		03/28/2013
Contract Detail	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	03/01/2013	04/01/2013		03/28/2013
Contract Detail	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	06/30/2016	07/01/2016		06/30/2016
Contract Detail	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	01/15/2019	04/01/2019		04/01/2019
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	03/01/2013	04/01/2013		03/28/2013
Contract Detail	BRFHH MONROE LLC	OCHSNER LSU HEALTH MONROE OUTPATIENT PHA	4864 JACKSON ST RM 1-161B	MONROE	LA	71202	07/22/2014	07/24/2014		07/24/2014
Contract Detail	BRFHH SHREVEPORT LLC	UNIVERSITY HEALTH SHREVEPORT	1606 KINGS HWY	SHREVEPORT	LA	71103-4128	01/07/2015	01/08/2015		01/08/2015
Contract Detail	DOC-YOUR-DOSE PHARMACY		17275 HWY 77	GROSSE TETE	LA	70740	10/09/2013	01/01/2014	11/01/2017	03/02/2020
Contract Detail	DOC-YOUR-DOSE PHARMACY	17275 HIGHWAY 77		GROSSE TETE	LA	70740-3008	04/13/2018	07/01/2018	04/24/2024	04/25/2024
Contract Detail	KINGS PHARMACY	3102 LINWOOD AVE		SHREVEPORT	LA	71103-4231	10/10/2014	01/01/2015		10/10/2014
Contract Detail	LALLIE KEMP REGIONAL MED CTR	LALLIE KEMP REGIONAL MEDICAL CENTER	52579 HIGHWAY 51 S	INDEPENDENCE	LA	70443-2231	04/06/2011	04/06/2011		03/28/2013
Contract Detail	MIDCITY PHARMACY	1401 N FOSTER DR		BATON ROUGE	LA	70806-1818	04/13/2018	07/01/2018		04/13/2018
Contract Detail	MOSS MEMORIAL CLINIC PHARMACY	1000 Walters St		Lake Charles	LA	70607	03/25/2014	04/01/2014		03/25/2014
Contract Detail	O'DONOVAN PHARMACY	5131 ODONOVAN DR STE 402		BATON ROUGE	LA	70808-4792	04/05/2013	04/14/2013	12/31/2019	03/02/2020
Contract Detail	OUR LADY OF THE ANGELS OUTPATIENT PHARMA	433 PLAZA ST RM 311		BOGALUSA	LA	70427-3729	07/22/2014	07/24/2014	04/24/2024	04/25/2024
Contract Detail	PARISH PHARMACY INC	DBA KINGS PHARMACY	3102 LINWOOD AVE	SHREVEPORT	LA	71103	04/11/2022	07/01/2022		07/01/2022
Contract Detail	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	10/09/2013	01/01/2014		10/09/2013
Contract Detail	SOUTHERN REGIONAL MEDICAL CORPORATION	DBA LEONARD J. CHABERT MEDICAL CENTER PH	1978 INDUSTRIAL BOULEVARD	HOUMA	LA	70363	03/25/2014	04/01/2014	04/19/2015	03/02/2020
Contract Detail	UNIVERSITY HOSPITAL & CLINICS, INC.	OUTPATIENT PHARMACY	2390 W CONGRESS ST	LAFAYETTE	LA	70506-4205	04/04/2014	04/07/2014		04/07/2014
Contract Detail	UNIVERSITY MEDICAL CENTER MANAGEMENT COR	UNIVERSITY MEDICAL CENTER NEW ORLEANS OU	2000 CANAL STREET (ROOM 4247)	NEW ORLEANS	LA	70112-3018	03/25/2014	04/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE #1502	2985 GAUSE BLVD E		SLIDELL	LA	70461	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC	WINN DIXIE PHARMACY # 1504	3030 PONTCHARTRAIN DR	SLIDELL	LA	70458	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1590	17682 AIRLINE HWY	PRAIRIEVILLE	LA	70769	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY #1453 6800 GREENWELL SPRINGS RD.	BATON ROUGE	LA	70805	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1454 5555 BURBANK DR	BATON ROUGE	LA	70820	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1461	8601 SIEGEN LANE	BATON ROUGE	LA	70810	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1467 13555 OLD HAMMOND HWY	BATON ROUGE	LA	70816	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1576	10974 JOOR RD	BATON ROUGE	LA	70818	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1577	13002 COURSEY BLVD	BATON ROUGE	LA	70816	10/09/2013	01/01/2014	04/24/2024	04/25/2024
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1581 5005 CHURCH ST	ZACHARY	LA	70791	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1405	2112 BELLE CHASSE HWY	GRETNA	LA	70056	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1425 3645 LAPALCO BLVD	HARVEY	LA	70058	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY #1428 3623 JEFFERSON HWY	JEFFERSON	LA	70121	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1406 4041 WILLIAMS BLVD	KENNER	LA	70065	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1412	2104 WILLIAMS BLVD	KENNER	LA	70062	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1329	211 VETERANS MEMORIAL BLVD	METAIRIE	LA	70005	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1411	5901 AIRLINE DR	METAIRIE	LA	70003	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1404	8601 JEFFERSON HWY	RIVER RIDGE	LA	70123	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1555 3803-F MOSS ST	LAFAYETTE	LA	70507	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1591 28145 WALKER SOUTH RD	WALKER	LA	70785	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1408 4600 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1426 3008 HOLIDAY DRIVE	NEW ORLEANS	LA	70131	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1430 5400 TCHOUPITOULAS STREET	NEW ORLEANS	LA	70115	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1588	12519 AIRLINE HWY, SUITE A	DESTREHAN	LA	70047	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1444	12125 HWY 90	LULING	LA	70070	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1583	1830 W AIRLINE HWY	LAPLACE	LA	70068	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1549	924 REES ST	BREAUX BRIDGE	LA	70517	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1448	2100 COLLINS BLVD. SUITE 132	COVINGTON	LA	70433	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1446	619 N CAUSEWAY BLVD	MANDEVILLE	LA	70448	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1500	4100 HWY 59	MANDEVILLE	LA	70471	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY # 1439	9701 CHEF MENTEUR HWY		NEW ORLEANS	LA	70127	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY # 1572	420 HOSPITAL ROAD		NEW ROADS	LA	70760	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1418	3001 HIGHWAY 90		AVONDALE	LA	70094	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1432	3300 PARIS RD		CHALMETTE	LA	70043	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1443	70431 HWY 21		COVINGTON	LA	70433	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1449	804 WEST OAK STREET		AMITE	LA	70422	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1456	1104 E MAIN ST		NEW IBERIA	LA	70560	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1463	1803 HWY 3125		GRAMERCY	LA	70052-5602	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1490	2004 N. PARKERSON AVE		CROWLEY	LA	70526	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1501	731 WASHINGTON STREET		FRANKLINTON	LA	70438	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1558	2210 VETERANS MEMORIAL DR		ABBEVILLE	LA	70510	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1559		204 NORTHWEST BLVD	FRANKLIN	LA	70538	10/08/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1561		2240 AMBASSADOR CAFFERY PKWY	LAFAYETTE	LA	70506	10/09/2013	01/01/2014	04/19/2015	03/02/2020
Contract Detail	WINN DIXIE PHARMACY #1570	1800 W LAUREL AVE		EUNICE	LA	70535	10/08/2013	01/01/2014	04/19/2015	03/02/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 10:08:10 AM	2/14/2025 10:13:58 AM	2/14/2025 10:13 AM
Details	Last Recertification Date	Update	Recertification	2/7/2023 1:41:47 PM	1/30/2024 10:08:10 AM	1/30/2024 10:08 AM
Details	NOFO Number	Update		HRSA-17-036		12/16/2023 10:34 AM
Details	Assistance Received From Date	Update	Recertification	4/1/2020 12:00:00 AM	4/1/2022 12:00:00 AM	2/7/2023 1:41 PM
Details	Assistance Received To Date	Update	Recertification	3/31/2021 12:00:00 AM	3/31/2027 12:00:00 AM	2/7/2023 1:41 PM
Details	Last Recertification Date	Update	Recertification	2/4/2022 4:08:54 PM	2/7/2023 1:41:47 PM	2/7/2023 1:41 PM
Details	Last Recertification Date	Update	Recertification	2/8/2021 8:09:59 AM	2/4/2022 4:08:54 PM	2/4/2022 4:08 PM
Contacts	Authorizing Official	Update	Change Request	Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program Louisiana Dept of Health 5045687474	Burgess, Samuel STD/HIV/Hepatitis Program Director Louisiana Office of Public Health 5045687474	6/4/2021 2:27 PM
Details	Assistance Received From Date	Update	Recertification		4/1/2020 12:00:00 AM	2/8/2021 8:09 AM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	2/8/2021 8:09 AM
Details	Last Recertification Date	Update	Recertification	2/9/2020 8:03:23 AM	2/8/2021 8:09:59 AM	2/8/2021 8:09 AM
Details	NOFO Number	Update	Recertification		HRSA-17-036	2/8/2021 8:09 AM
Details	Grant Number	Update	Change Request	ADAPD-LA	X07HA00018	1/25/2021 8:59 AM
Details	Last Recertification Date	Update	Recertification	2/23/2019 11:53:08 AM	2/9/2020 8:03:23 AM	2/9/2020 8:03 AM
Contacts	Primary Contact	Update	Recertification	MICHAEL, LEAH ACTING DIRECTOR OF PHARMACY OPERATIONS Louisiana Office of Public Health 5045685022	Arnold, Matthew LDAP Coordinator Lousiaiana Office of Public Health STD/HIV Program 5045687474	2/23/2019 11:53 AM
Details	Last Recertification Date	Update	Recertification	2/13/2018 3:05:43 PM	2/23/2019 11:53:08 AM	2/23/2019 11:53 AM
Addresses	Main Address	Update	Change Request	1450 POYDRAS ST. RM 1915 NEW ORLEANS, LA 70112	1450 POYDRAS ST. Suite 2136 NEW ORLEANS, LA 70112	1/16/2019 11:21 AM
Details	Last Recertification Date	Update	Recertification	2/4/2017 12:00:00 AM	2/13/2018 3:05:43 PM	2/13/2018 3:05 PM
Contacts	Primary Contact	Update	Change Request	Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program Louisiana Dept of Health 5045687474	MICHAEL, LEAH ACTING DIRECTOR OF PHARMACY OPERATIONS Louisiana Office of Public Health 5045685022	1/29/2018 4:13 PM
Contacts	Authorizing Official	Update		Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program 5045687474	Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program Louisiana Dept of Health 5045687474	10/15/2017 7:35 PM
Contacts	Primary Contact	Update		Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program 5045687474	Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program Louisiana Dept of Health 5045687474	10/15/2017 7:35 PM
Contacts	Authorizing Official	Insert			Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program 5045687474	7/7/2017 8:14 AM
Contacts	Primary Contact	Insert			Gruber, DeAnn Administrative Director Louisiana OPH STD/HIV Program 5045687474	7/7/2017 8:14 AM
Addresses	Main Address	Insert			1450 POYDRAS ST. RM 1915 NEW ORLEANS, LA 70112	2/4/2017 12:32 PM
Details	Last Recertification Date	Update		3/4/2016 12:00:00 AM	2/4/2017 12:00:00 AM	2/4/2017 12:32 PM
Details	Last Recertification Date	Update		1/30/2015 12:00:00 AM	3/4/2016 12:00:00 AM	3/4/2016 11:35 AM
Details	Last Recertification Date	Update		2/27/2014 12:00:00 AM	1/30/2015 12:00:00 AM	1/30/2015 7:19 PM
Details	Last Recertification Date	Update		1/1/2013 12:00:00 AM	2/27/2014 12:00:00 AM	2/27/2014 1:55 PM
Details	Last Recertification Date	Update		10/1/2011 12:00:00 AM	1/1/2013 12:00:00 AM	11/15/2012 6:02 AM
Details	Entity Name	Update		HIV/AIDS PROGRAM	STD/HIV Program	6/28/2012 3:18 PM
Details	Last Recertification Date	Update		10/1/2010 12:00:00 AM	10/1/2011 12:00:00 AM	9/29/2011 8:02 PM
Details	Last Recertification Date	Insert			10/1/2010 12:00:00 AM	5/16/2011 1:45 PM
Details	Grant Number	Insert			ADAPD-LA	5/16/2011 1:45 PM
Details	340B ID	Insert			RWIID70112	5/16/2011 1:45 PM
Details	Is Authorizing Official EHB Data	Insert				5/16/2011 1:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/16/2011 1:45 PM
Details	Medicare Provider Number	Insert				5/16/2011 1:45 PM
Details	Entity Name	Insert			HIV/AIDS PROGRAM	5/16/2011 1:45 PM
Details	Program Code	Insert			RWIID	5/16/2011 1:45 PM
Details	Entity Subname	Insert			OFFICE OF PUBLIC HEALTH	5/16/2011 1:45 PM
Dates	Participating Approval Date	Insert			6/9/2005 12:00:00 AM	5/16/2011 1:45 PM
Details	State	Insert			Active	5/16/2011 1:45 PM
Dates	Registration Date	Insert			7/1/1998 12:00:00 AM	5/16/2011 1:45 PM
Dates	Signed By Date	Insert			10/1/2010 12:00:00 AM	5/16/2011 1:45 PM
Dates	Start Date	Insert			7/1/1998 12:00:00 AM	5/16/2011 1:45 PM
Terminations	Termination Comments	Insert				5/16/2011 1:45 PM
Terminations	Termination Date	Insert				5/16/2011 1:45 PM
Terminations	Termination Effective Date	Insert				5/16/2011 1:45 PM
Terminations	Termination Reason	Insert				5/16/2011 1:45 PM
Details	Comments Public	Insert			5/16/11 UPDATED ZIP (WAS 70113); 4/19/11 PHYS ADDR CHANGE (WAS 1010 COMMON ST, 11TH FLOOR)4/17/06 ADDR CHANGE (WAS 234 LOYOLA AVENUE, 5TH FLOOR), 3/22/06 NEW 340B ID # (WAS RW701121), ADDR CHANGE (WAS 325 LOYOLA AVE., 2ND FLOOR)	5/16/2011 1:45 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History