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WALGREEN LOUISIANA CO., INC.
CHC26579-02 C A S S E DENTAL HEALTH INSTITUTE
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Covered Entity Details
Entity Name
C A S S E DENTAL HEALTH INSTITUTE
Subdivision Name
CASSE-Bert Kouns Site
Type
HRSA-Funded Health Center
340B ID
CHC26579-02
Entity Address
2120 Bert Kouns
Ste. A
Shreveport, LA 71118-3354
Grant Number
H80CS26579
Participating Start Date
7/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 04998
9209 MANSFIELD RD.
SHREVEPORT, LA 71118
Pharmacy Comments
Contract Details
Approval Date
10/2/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Moody, C. O. O.
(318) 688-3350
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/2/2018
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