340B Drug Pricing Program Database


CH06757E Capitol City Family Health Center Inc (Active) - information as of 5/27/2025 4:05:10 PM

Main Details
Capitol City Family Health Center Inc
CareSouth-Shreveport
HRSA-Funded Health Center
BPS-H80-033993
CH06757E
H80CS00504


Additional Details
Active
7/1/2022
10/1/2022
7/6/2022
2/11/2025

Contacts

Capitol City Family Health Center
Matthew Valliere, Chief Executive Officer
(225) 650-2026

Capitol City Family Health Center
Maimouna Keita, Chief Financial Officer
(225) 650-2024

Addresses

8730 Youree Dr Ste A-B
Shreveport, LA 71115-2500

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
Shipping Addresses

Care South Pharmacy 3
8730 Youree Dr
Shreveport, LA 71115-2500
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH067570ActiveBPS-H80-000579CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTHCAPITOL CITY FAMILY HEALTH CENTER, INC dba CARESOUTH3140 FLORIDA BLVD BATON ROUGELA
CH06757BActiveBPS-H80-011988CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTHCapitol City Family Health Center @ Donaldsonville904 Catalpa Street DonaldsonvilleLA
CH06757CActiveBPS-H80-013699CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTHCapitol City Family Health Center- Plaquemine (Iberville Parish)59340 River West Drive PlaquemineLA
CH06757DActiveBPS-H80-019658Capitol City Family Health Center IncCARESOUTH BEHAVIORAL HEALTH AT ZACHARY, LA4852 HWY 19, SUITE A ZACHARYLA
CH06757EActiveBPS-H80-033993Capitol City Family Health Center IncCareSouth-Shreveport8730 Youree Dr Ste A-B ShreveportLA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH067570ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/01/2022  
CH067570ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/01/2022  
CH067570ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/01/2022  
CH067570ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624101/01/2022  
CH067570ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/01/2022  
CH067570ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/01/2022  
CH067570AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271207/01/2017  
CH067570AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291104/01/2018  
CH067570AVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011902/09/2012  
CH06757BAVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011901/01/2013  
CH067570AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080802/09/2012  
CH067570AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503407/01/2019  
CH067570BIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005804/01/2025  
CH067570BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/01/2017  
CH067570BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771310/01/2020  
CH067570BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/2024  
CH067570BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/01/2024  
CH067570BROWN'S PHARMACY LLC1718 N FOSTER DR STE B
BATON ROUGELA70806-107601/01/2015 12/01/2023
CH06757BBROWN'S PHARMACY LLC1718 N FOSTER DR STE B
BATON ROUGELA70806-107601/01/2015  
CH06757CBROWN'S PHARMACY LLC1718 N FOSTER DR STE B
BATON ROUGELA70806-107601/01/2015  
CH067570CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2023  
CH067570CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2023  
CH067570CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2023  
CH067570CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2023  
CH067570CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2023  
CH067570CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2023  
CH067570CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2023  
CH067570CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2023  
CH067570CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2023  
CH067570CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2023  
CH067570CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2018  
CH067570CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2018  
CH067570CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2023  
CH067570DELIVERCARERX PHARMACY LLCDELIVERCARERX PHARMACY LLC 1471 E BUSINESS CENTER DR
STE 200
MT PROSPECTIL6005607/01/2017  
CH067570DOC-YOUR-DOSE PHARMACY  17275 HWY 77
GROSSE TETELA7074003/11/2010 12/01/2023
CH067570DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654110/01/2020  
CH067570DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K
GREENVILLESC29607-654010/01/2018  
CH067570ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/01/2022  
CH067570EXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412510/01/2020 02/10/2023
CH067570EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/01/2022  
CH067570EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/01/2022  
CH067570EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/01/2022  
CH067570INVERNESS APOTHECARY TRINITY24333 GORDON TERRY PARKWAY SUITE B
TRINITYAL3567307/01/2018  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01116 7777 BLUEBONNET BLVD,, SUITE 100
BATON ROUGELA7081007/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01661 17122 AIRLINE HWY.
PRAIRIEVILLELA7076907/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #1924 20501 OLD SCENIC HWY
ZACHARYLA70791-736507/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04761 3200 HIGLAND ROAD
BATON ROUGELA7080207/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05317 11430 FLORIDA BLVD
BATON ROUGELA7081507/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05319 5889 AIRLINE HWY
BATON ROUGELA7080507/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05322 9608 JEFFERSON HWY
BATON ROUGELA7080907/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05324 3384 GOVERNMENT ST
BATON ROUGELA7080607/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05343 15255 GEORGE ONEAL RD
SUITE A
BATON ROUGELA7081707/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05354 1624 N. BURNSIDE
GONZALESLA7073707/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05374 14360 WAX ROAD
BATON ROUGELA7081807/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05510 11705 COURSEY BLVD.
BATON ROUGELA7081607/01/2019 01/11/2023
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05615 2520 PLANK RD
BATON ROUGELA7080507/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY #06124 7411 FLORIDA BLVD.
BATON ROUGELA7080607/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08309 5360 HIGHLAND RD.,
BATON ROUGELA7080807/01/2019  
CH067570LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05321 1214 MAIN ST
BAKERLA7071410/01/2019  
CH067570M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312604/01/2018  
CH067570NOAH'S PHARMACY400 W ST FRANCIS ST
BRUSLYLA7071907/01/2016 02/05/2024
CH067570OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276507/01/2024  
CH067570OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/01/2025  
CH067570OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2023  
CH067570OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824910/01/2024  
CH067570OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265507/01/2023  
CH067570OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/01/2025  
CH067570OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/01/2024  
CH067570PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310104/01/2018  
CH067570PRAXIS SPECIALTY PHARMACY LLCPRAXIS RX PHARMACY 5455 W WATERS AVE STE 214
TAMPAFL3363407/01/2019  
CH067570PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2023  
CH067570PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2023  
CH067570PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2023  
CH067570PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2023  
CH067570PROPRIUM SOLUTIONS L.L.C3710 YOUREE DR
SHREVEPORTLA7110504/01/2024  
CH067570RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255010/01/2018  
CH067570RELIANT MEDICAL LLC DBA RELIANT HEALTHCA1004 N 19TH ST
MONROELA71201-573407/01/2016  
CH06757BRELIANT MEDICAL LLC DBA RELIANT HEALTHCA1004 N 19TH ST
MONROELA71201-573407/01/2016  
CH06757CRELIANT MEDICAL LLC DBA RELIANT HEALTHCA1004 N 19TH ST
MONROELA71201-573407/01/2016  
CH067570RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500210/01/2018  
CH067570SENDERRA RX PHARMACYSENDERRA RX PARTNERS, LLC 3712 E PLANO PKWY STE 200
PLANOTX7507407/01/2021 02/28/2024
CH067570SPECIALTY CARE RX, LLC150 COLLINS ST
MEMPHISTN3811207/01/2018  
CH067570VITAL RX LLC237 CAHABA VALLEY PARKWAY
PELHAMAL3512407/01/2018 02/05/2024
CH067570VITAL RX OF LOUISIANA6200 LESLIE LN
LAKE CHARLESLA7061507/01/2018 02/05/2024
CH067570WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2021  
CH067570WAL-MART PHARMACY 10-040159690 BELLVIEW DR
PLAQUEMINELA7076404/01/2018  
CH067570WAL-MART PHARMACY 10-08399350 CORTANA PL
BATON ROUGELA7081504/01/2018  
CH067570WAL-MART PHARMACY 10-110214507 PLANK ROAD
BAKERLA7071404/01/2018  
CH067570WAL-MART PHARMACY 10-12063132 COLLEGE DR.
BATON ROUGELA7080804/01/2018  
CH067570WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02995 3550 GOVERNMENT ST
BATON ROUGELA7080610/01/2016  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 09860 5955 AIRLINE HWY
BATON ROUGELA70805-320210/01/2016 04/02/2024
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02982 5450 PLANK ROAD
BATON ROUGELA7080510/01/2016  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 09753 1125 MARCHAND DR
DONALDSONVILLELA70346-859610/01/2016 02/21/2023
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02996 11297 FLORIDA BLVD
BATON ROUGELA7081510/01/2016  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07836 3671 JOOR ROAD
BATON ROUGELA70814-310410/01/2016  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13925 5298 HIGHLAND RD.
BATON ROUGELA70808-653010/01/2016  
CH067570WALGREEN LOUISIANA CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16478 5555 ESSEN LN STE C
BATON ROUGELA7080901/01/2019  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 11498 5061 MAIN STREET
ZACHARYLA7079101/01/2019  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02980 4747 S SHERWOOD FOREST
BATON ROUGELA7081607/01/2019  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07440 2001 ONEAL LANE
BATON ROUGELA70816-320401/01/2020  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03085 14444 COURSEY BLVD.
BATON ROUGELA7081704/01/2020  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 06028 9820 OLD HAMMOND HWY
BATON ROUGELA7081604/01/2020  
CH067570WALGREEN LOUISIANA CO., INC.WALGREENS #17423 2152 S SHERWOOD FOREST BLVD
BATON ROUGELA70816-832704/01/2020 11/07/2022
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03610 12881 PERKINS RD.
BATON ROUGELA7081001/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13875 6485 GROOM RD
BAKERLA7071401/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07083 9983 BLUEBONNET BLVD
BATON ROUGELA7081007/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.DBA:WALGREENS #15366 220 N ALEXANDER AVE
PORT ALLENLA70767-251407/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.WALGREENS #21157 24555 HIGHWAY 1
PLAQUEMINELA70764-417107/01/2021  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03047 5112 ESSEN LANE
BATON ROUGELA7080904/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03180 101 FLORIDA AVE. SE
DENHAM SPRINGSLA7072604/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03399 7620 JEFFERSON HIGHWAY
BATON ROUGELA7080904/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 06448 4485 PERKINS ROAD
BATON ROUGELA70808-303404/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07795 6515 SULLIVAN RD
GREENWELL SPRINGSLA70739-311004/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #09518 15929 AIRLINE HWY
BATON ROUGELA7081704/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 10400 34865 LA HWY 16
DENHAM SPRINGSLA70706-066904/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11196 12506 HIGHWAY 73
GEISMARLA70734-320904/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11281 1607 N. AIRLINE HWY.
GONZALESLA7073704/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11413 105 WEST HIGHWAY 30
GONZALESLA70737-480204/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11762 10200 FLORIDA BLVD
WALKERLA7078504/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13080 3081 S. RANGE AVE
DENHAM SPRINGSLA7072604/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.DBA:WALGREENS #13779 39527 HWY 42
PRAIRIEVILLELA7076904/01/2022  
CH067570WALGREEN LOUISIANA CO., INC.WALGREENS #17647 2159 STARING LN
BATON ROUGELA70810-103804/01/2022 11/17/2022
CH067570Walgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200
NorthlakeTX7626207/01/2023  
CH067570WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2024  
CH067570WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2024  
CH067570WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2024  
CH067570WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275607/01/2023  
CH067570Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/7/2024 1:07:26 PM2/11/2025 2:49:33 PM2/11/2025 2:49 PM
AddressesShipping AddressDeleteChange RequestCapitol City Family Health Center Inc. (CareSouth-Shreveport) 8730 Youree Dr. Suite B Shreveport, LA 71115 4/11/2024 12:25 PM
AddressesShipping AddressInsertChange Request Care South Pharmacy 3 8730 Youree Dr Shreveport, LA 71115-25004/11/2024 12:25 PM
AddressesMain AddressUpdateRecertification 8730 Youree Dr Ste A-B Shreveport, LA 70791-2500 8730 Youree Dr Ste A-B Shreveport, LA 71115-25002/7/2024 1:07 PM
DetailsLast Recertification DateUpdateRecertification2/9/2023 12:42:26 PM2/7/2024 1:07:26 PM2/7/2024 1:07 PM
AddressesShipping AddressInsertChange Request Capitol City Family Health Center Inc. (CareSouth-Shreveport) 8730 Youree Dr. Suite B Shreveport, LA 7111510/31/2023 1:26 PM
AddressesMain AddressUpdateChange Request 8730 Youree Dr Ste A-B Shreveport, LA 71115-2500 8730 Youree Dr Ste A-B Shreveport, LA 70791-250010/31/2023 12:59 PM
DetailsLast Recertification DateUpdateRecertification 2/9/2023 12:42:26 PM2/9/2023 12:42 PM
DetailsStateUpdate ApprovedActive10/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Valliere, Matthew Chief Executive Officer Capitol City Family Health Center 22565020267/6/2022 7:40 AM
Details340B IDUpdateNew Registration CH06757E7/6/2022 7:40 AM
DatesParticipating Approval DateUpdateNew Registration 7/6/2022 7:40:51 AM7/6/2022 7:40 AM
DetailsStateUpdateNew RegistrationPendingApproved7/6/2022 7:40 AM
DatesSigned By DateUpdateNew Registration 7/1/2022 2:40:14 PM7/6/2022 7:40 AM
DatesStart DateUpdateNew Registration 10/1/2022 12:00:00 AM7/6/2022 7:40 AM
AddressesMain AddressInsertNew Registration  8730 Youree Dr Ste A-B Shreveport, LA 71115-25007/1/2022 2:40 PM
Medicaid BillingNPI: NumberInsertNew Registration 17500200537/1/2022 2:40 PM
Medicaid BillingNPI: StateInsertNew Registration LA7/1/2022 2:40 PM
ContactsPrimary ContactInsertNew Registration Keita, Maimouna Chief Financial Officer Capitol City Family Health Center 22565020247/1/2022 2:40 PM
ContactsAuthorizing OfficialInsertNew Registration Valliere, Matthew Chief Executive Officer Capitol City Family Health Center 22565020267/1/2022 2:40 PM
DetailsAssistance Received From DateInsertNew Registration  7/1/2022 2:40 PM
DetailsAssistance Received To DateInsertNew Registration  7/1/2022 2:40 PM
DetailsLast Recertification DateInsertNew Registration  7/1/2022 2:40 PM
DetailsGrant NumberInsertNew Registration H80CS005047/1/2022 2:40 PM
Details340B IDInsertNew Registration  7/1/2022 2:40 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/1/2022 2:40 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/1/2022 2:40 PM
DetailsMedicare Provider NumberInsertNew Registration  7/1/2022 2:40 PM
DetailsEntity NameInsertNew Registration Capitol City Family Health Center Inc7/1/2022 2:40 PM
DetailsNOFO NumberInsertNew Registration  7/1/2022 2:40 PM
DetailsProgram CodeInsertNew Registration CH7/1/2022 2:40 PM
DetailsEntity SubnameInsertNew Registration CareSouth-Shreveport7/1/2022 2:40 PM
DatesParticipating Approval DateInsertNew Registration  7/1/2022 2:40 PM
DetailsStateInsertNew Registration Pending7/1/2022 2:40 PM
DatesRegistration DateInsertNew Registration 7/1/2022 2:40:11 PM7/1/2022 2:40 PM
DatesSigned By DateInsertNew Registration  7/1/2022 2:40 PM
DatesStart DateInsertNew Registration  7/1/2022 2:40 PM
TerminationsTermination CommentsInsertNew Registration  7/1/2022 2:40 PM
TerminationsTermination DateInsertNew Registration  7/1/2022 2:40 PM
TerminationsTermination Effective DateInsertNew Registration  7/1/2022 2:40 PM
TerminationsTermination ReasonInsertNew Registration  7/1/2022 2:40 PM