Covered Entity Details

CHC28964-07 START CORP (Active) - information as of 4/29/2025 11:55:16 PM

Main Details

Name

START CORP

Subdivision Name

Start Community Health Center - Downtown Mandeville

Type

HRSA-Funded Health Center

Site ID

BPS-H80-036508

340B ID

CHC28964-07

Grant Number

H80CS28964

Additional Details

Current Program Status

Active

Registration Date

7/11/2023

Participating Start Date

10/1/2023

Participating Approval Date

7/13/2023

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Start Community Health Center
Catherine Broussard, QA/Compliance Officer
(985) 333-2020 Ext: 2005

Primary Contact

Start Corporation
Trudy Franks, Clinic Director
(985) 333-2020 Ext: 2001

Addresses

Street Address

2150 General Pershing Street Mandeville
Mandeville, LA 70448

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
LA	2208527	1306426135

Shipping Addresses

Shipping Address 1

START Pharmacy
235 Civic Center Blvd
Suite 136
Houma, LA 70360

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	07/13/2023	10/01/2023	10/01/2023
Contract Detail	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	07/13/2023	10/01/2023	10/01/2023
Contract Detail	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/13/2023	10/01/2023	10/01/2023
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	07/13/2023	10/01/2023	10/01/2023
Contract Detail	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	07/13/2023	10/01/2023	10/01/2023
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03440	2880 HIGHWAY 190	MANDEVILLE	LA	70471	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05382	4330 HWY 22	MANDEVILLE	LA	70471	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06849	2050 FLORIDA STREET	MANDEVILLE	LA	70448	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09645	73626 HWY 25	COVINGTON	LA	70435-5600	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	07/13/2023	10/01/2023	10/01/2023
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	07/13/2023	10/01/2023	10/01/2023
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/13/2023	10/01/2023	10/01/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC28964-00	Active	BPS-H80-015388	START CORPORATION	Start Community Health Center	420 MAGNOLIA ST	HOUMA	LA
CHC28964-01	Active	BPS-H80-021901	START CORPORATION	Theodore Duhe Center	235 Civic Center Blvd	Houma	LA
CHC28964-02	Terminated	BPS-H80-022285	START CORPORATION	Start CHC- New Orleans	701 Loyola Ave	New Orleans	LA
CHC28964-03	Active	BPS-H80-022289	START CORPORATION	Start CHC- Covington	1505 North Florida St.	Covington	LA
CHC28964-04	Active	BPS-H80-032139	START CORP	Start Community Health Center - Galvez	2300 S Galvez St	New Orleans	LA
CHC28964-05	Active	BPS-H80-034490	START CORP	Start Community Health Center - One Stop	153 N 17th St	Baton Rouge	LA
CHC28964-06	Active	BPS-H80-034908	START CORP	Start Community Health Center - Thibodaux	312 E Bayou Rd	Thibodaux	LA
CHC28964-07	Active	BPS-H80-036508	START CORP	Start Community Health Center - Downtown Mandeville	2150 General Pershing Street Mandeville	Mandeville	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC28964-00	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	04/01/2017
CHC28964-01	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2020
CHC28964-02	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2020
CHC28964-04	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2022
CHC28964-05	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2023
CHC28964-06	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2023
CHC28964-07	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2023
CHC28964-00	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	04/01/2017
CHC28964-01	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	01/01/2020
CHC28964-02	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	01/01/2020
CHC28964-04	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2022
CHC28964-05	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2023
CHC28964-06	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2023
CHC28964-07	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2023
CHC28964-00	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	04/01/2017
CHC28964-01	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/01/2020
CHC28964-02	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/01/2020
CHC28964-04	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2022
CHC28964-05	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2023
CHC28964-06	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2023
CHC28964-07	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2023
CHC28964-00	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	04/01/2017
CHC28964-01	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	01/01/2020
CHC28964-02	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	01/01/2020
CHC28964-04	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	10/01/2022
CHC28964-05	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	10/01/2023
CHC28964-06	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	10/01/2023
CHC28964-07	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	10/01/2023
CHC28964-00	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2019
CHC28964-01	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	01/01/2020
CHC28964-02	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	01/01/2020
CHC28964-04	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2022
CHC28964-05	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2023
CHC28964-06	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2023
CHC28964-07	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2023
CHC28964-00	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/01/2017
CHC28964-01	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2020
CHC28964-02	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2020	01/01/2025
CHC28964-03	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2020
CHC28964-04	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2022
CHC28964-05	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2023
CHC28964-06	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2023
CHC28964-07	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2023
CHC28964-00	EXPRESSWAY PHARMACY	EXPRESSWAY PHARMACY	315 WESTBANK EXPY	GRETNA	LA	70053-5616	01/01/2018	10/01/2019
CHC28964-01	PEOPLES DRUG STORE	7869 MAIN ST		HOUMA	LA	70360	01/01/2020
CHC28964-02	PEOPLES DRUG STORE	7869 MAIN ST		HOUMA	LA	70360	01/01/2020	01/01/2025
CHC28964-03	PEOPLES DRUG STORE	7869 MAIN ST		HOUMA	LA	70360	01/01/2020
CHC28964-00	PEOPLES DRUG STORE	7869 MAIN ST		HOUMA	LA	70360	01/01/2020
CHC28964-06	PEOPLES DRUG STORE	7869 MAIN ST		HOUMA	LA	70360	10/01/2023
CHC28964-06	WALGREEN LOUISIANA CO,. INC.	DBA: WALGREENS #12626	1000 S ACADIA ROAD	THIBODAUX	LA	70301	10/01/2023
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	01/01/2021
CHC28964-01	WALGREEN LOUISIANA CO., INC.	WALGREENS #17092	1214 GRAND CAILLOU RD	HOUMA	LA	70363-5555	01/01/2021
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	01/01/2021	01/01/2025
CHC28964-02	WALGREEN LOUISIANA CO., INC.	WALGREENS #17092	1214 GRAND CAILLOU RD	HOUMA	LA	70363-5555	01/01/2021	01/01/2025
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	01/01/2021
CHC28964-03	WALGREEN LOUISIANA CO., INC.	WALGREENS #17092	1214 GRAND CAILLOU RD	HOUMA	LA	70363-5555	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	WALGREENS #17092	1214 GRAND CAILLOU RD	HOUMA	LA	70363-5555	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	01/01/2021
CHC28964-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	01/01/2021
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	WALGREENS #17092	1214 GRAND CAILLOU RD	HOUMA	LA	70363-5555	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04304	145 ELK PLACE	NEW ORLEANS	LA	70112	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07277	4350 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131-8643	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02640	3227 MAGAZINE ST	NEW ORLEANS	LA	70115	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04450	718 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07262	2669 CANAL ST	NEW ORLEANS	LA	70119-6409	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10316	4001 CANAL ST	NEW ORLEANS	LA	70119	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	WALGREENS #17089	760 HARRISON AVE	NEW ORLEANS	LA	70124-3156	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05551	619 DECATUR ST	NEW ORLEANS	LA	70130	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12557	4550 GENERAL MEYER AVE	NEW ORLEANS	LA	70131	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15199	5518 MAGAZINE STREET	NEW ORLEANS	LA	70115-3152	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07264	4115 JEFFERSON HWY	NEW ORLEANS	LA	70121-1533	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07266	3100 GENTILLY BLVD	NEW ORLEANS	LA	70122-3854	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #05866	2418 S. CARROLLTON AVE	NEW ORLEANS	LA	70118-3012	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #16309	1401 FOUCHER ST STE C-309	NEW ORLEANS	LA	70115	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11496	101 ALLEN TOUSSAINT BLVD	NEW ORLEANS	LA	70124	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04305	900 CANAL	NEW ORLEANS	LA	70112	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21176	925 COMMON ST STE A	NEW ORLEANS	LA	70112	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07255	3401 SAINT CHARLES AVE	NEW ORLEANS	LA	70115-4535	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	10/01/2022
CHC28964-04	WALGREEN LOUISIANA CO., INC.	RITE AID #07276	5661 BULLARD AVE	NEW ORLEANS	LA	70128-3447	10/01/2022
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12557	4550 GENERAL MEYER AVE	NEW ORLEANS	LA	70131	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03047	5112 ESSEN LANE	BATON ROUGE	LA	70809	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10316	4001 CANAL ST	NEW ORLEANS	LA	70119	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04305	900 CANAL	NEW ORLEANS	LA	70112	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15199	5518 MAGAZINE STREET	NEW ORLEANS	LA	70115-3152	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02640	3227 MAGAZINE ST	NEW ORLEANS	LA	70115	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04450	718 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #05866	2418 S. CARROLLTON AVE	NEW ORLEANS	LA	70118-3012	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11496	101 ALLEN TOUSSAINT BLVD	NEW ORLEANS	LA	70124	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05551	619 DECATUR ST	NEW ORLEANS	LA	70130	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04304	145 ELK PLACE	NEW ORLEANS	LA	70112	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07095	1435 W TUNNEL BLVD	HOUMA	LA	70360-2738	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11138	1415 ST CHARLES ST	HOUMA	LA	70360-3964	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03432	1511 E TUNNEL BLVD	HOUMA	LA	70363	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10267	5831 W PARK AVE	HOUMA	LA	70364	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15546	9303 PARK AVE	HOUMA	LA	70363	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02995	3550 GOVERNMENT ST	BATON ROUGE	LA	70806	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09860	5955 AIRLINE HWY	BATON ROUGE	LA	70805-3202	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03610	12881 PERKINS RD.	BATON ROUGE	LA	70810	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02996	11297 FLORIDA BLVD	BATON ROUGE	LA	70815	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06028	9820 OLD HAMMOND HWY	BATON ROUGE	LA	70816	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02980	4747 S SHERWOOD FOREST	BATON ROUGE	LA	70816	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03399	7620 JEFFERSON HIGHWAY	BATON ROUGE	LA	70809	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06448	4485 PERKINS ROAD	BATON ROUGE	LA	70808-3034	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07083	9983 BLUEBONNET BLVD	BATON ROUGE	LA	70810	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07440	2001 ONEAL LANE	BATON ROUGE	LA	70816-3204	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #09518	15929 AIRLINE HWY	BATON ROUGE	LA	70817	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03085	14444 COURSEY BLVD.	BATON ROUGE	LA	70817	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02982	5450 PLANK ROAD	BATON ROUGE	LA	70805	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07836	3671 JOOR ROAD	BATON ROUGE	LA	70814-3104	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13925	5298 HIGHLAND RD.	BATON ROUGE	LA	70808-6530	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16478	5555 ESSEN LN STE C	BATON ROUGE	LA	70809	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07315	3433 GOVERNMENT ST	BATON ROUGE	LA	70806-5717	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07316	7570 JEFFERSON HWY	BATON ROUGE	LA	70806-8307	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	WALGREENS #17647	2159 STARING LN	BATON ROUGE	LA	70810-1038	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07319	9031 SIEGAN LN	BATON ROUGE	LA	70810-1951	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07320	12308 PLANK RD	BATON ROUGE	LA	70811-1037	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #007321	11080 GREENWELL SPRINGS RD	BATON ROUGE	LA	70814-7001	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07325	1029 MILLERVILLE RD	BATON ROUGE	LA	70816-1277	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	WALGREENS #17423	2152 S SHERWOOD FOREST BLVD	BATON ROUGE	LA	70816-8327	10/01/2023
CHC28964-05	WALGREEN LOUISIANA CO., INC.	RITE AID #07384	4848 ONEAL LN	BATON ROUGE	LA	70817-1639	10/01/2023
CHC28964-06	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04140	195 N. CANAL BLVD	THIBODAUX	LA	70301	10/01/2023
CHC28964-06	WALGREEN LOUISIANA CO., INC.	WALGREENS #17342	1625 SAINT MARY ST	THIBODAUX	LA	70301-6491	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09990	71041 HIGHWAY 21	COVINGTON	LA	70433	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03990	1203 BUSINESS 190	COVINGTON	LA	70433-3278	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03440	2880 HIGHWAY 190	MANDEVILLE	LA	70471	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05382	4330 HWY 22	MANDEVILLE	LA	70471	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06849	2050 FLORIDA STREET	MANDEVILLE	LA	70448	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09645	73626 HWY 25	COVINGTON	LA	70435-5600	10/01/2023
CHC28964-03	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09645	73626 HWY 25	COVINGTON	LA	70435-5600	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	10/01/2023
CHC28964-07	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	10/01/2023
CHC28964-04	WALGREENS	WALGREEN LOUISIANA CO, INC	(02833) 5500 ST CLAUDE AVE	NEW ORLEANS	LA	70117	10/01/2022
CHC28964-04	WALGREENS		WALGREEN LA CO., INC (02715) 9999 LAKE FOREST BLVD	NEW ORLEANS	LA	70127	10/01/2022
CHC28964-01	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2023
CHC28964-03	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2023
CHC28964-04	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2023
CHC28964-05	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2023
CHC28964-07	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2023
CHC28964-02	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	01/01/2024	01/01/2025
CHC28964-06	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	01/01/2024
CHC28964-00	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/01/2024
CHC28964-04	WALGREENS LOUISIANA CO		DBA: WALGREENS #2649 3033 S. CARROLLTON	NEW ORLEANS	LA	70118	10/01/2022
CHC28964-04	WALGREENS LOUISIANA CO	DBA: WALGREEN #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	10/01/2022
CHC28964-05	WALGREENS LOUISIANA CO	DBA: WALGREEN #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/16/2024 9:44:19 AM	2/12/2025 2:22:57 PM	2/12/2025 2:22 PM
Details	Last Recertification Date	Update	Recertification		2/16/2024 9:44:19 AM	2/16/2024 9:44 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Broussard, Catherine QA/Compliance Officer Start Community Health Center 9853332020-2005	7/13/2023 1:14 PM
Details	340B ID	Update	New Registration		CHC28964-07	7/13/2023 1:14 PM
Dates	Participating Approval Date	Update	New Registration		7/13/2023 1:14:16 PM	7/13/2023 1:14 PM
Details	State	Update	New Registration	Pending	Approved	7/13/2023 1:14 PM
Dates	Signed By Date	Update	New Registration		7/11/2023 4:47:03 PM	7/13/2023 1:14 PM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	7/13/2023 1:14 PM
Addresses	Main Address	Insert	New Registration		2150 General Pershing Street Mandeville Mandeville, LA 70448	7/11/2023 4:47 PM
Addresses	Shipping Address	Insert	New Registration		START Pharmacy 235 Civic Center Blvd Suite 136 Houma, LA 70360	7/11/2023 4:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2023 4:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2208527	7/11/2023 4:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	7/11/2023 4:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306426135	7/11/2023 4:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	7/11/2023 4:47 PM
Contacts	Primary Contact	Insert	New Registration		Franks, Trudy Clinic Director Start Corporation 9853332020-2001	7/11/2023 4:47 PM
Contacts	Authorizing Official	Insert	New Registration		Broussard, Catherine QA/Compliance Officer Start Community Health Center 9853332020-2005	7/11/2023 4:47 PM
Details	Assistance Received From Date	Insert	New Registration			7/11/2023 4:47 PM
Details	Assistance Received To Date	Insert	New Registration			7/11/2023 4:47 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2023 4:47 PM
Details	Grant Number	Insert	New Registration		H80CS28964	7/11/2023 4:47 PM
Details	340B ID	Insert	New Registration			7/11/2023 4:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2023 4:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2023 4:47 PM
Details	Medicare Provider Number	Insert	New Registration			7/11/2023 4:47 PM
Details	Entity Name	Insert	New Registration		START CORP	7/11/2023 4:47 PM
Details	NOFO Number	Insert	New Registration			7/11/2023 4:47 PM
Details	Program Code	Insert	New Registration		CH	7/11/2023 4:47 PM
Details	Entity Subname	Insert	New Registration		Start Community Health Center - Downtown Mandeville	7/11/2023 4:47 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2023 4:47 PM
Details	State	Insert	New Registration		Pending	7/11/2023 4:47 PM
Dates	Registration Date	Insert	New Registration		7/11/2023 4:47:00 PM	7/11/2023 4:47 PM
Dates	Signed By Date	Insert	New Registration			7/11/2023 4:47 PM
Dates	Start Date	Insert	New Registration			7/11/2023 4:47 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2023 4:47 PM
Terminations	Termination Date	Insert	New Registration			7/11/2023 4:47 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2023 4:47 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2023 4:47 PM

340B Drug Pricing Program Database