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WINN DIXIE PHARMACY # 1439
CH062870 EXCELTH, INCORPORATED
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Covered Entity Details
Entity Name
EXCELTH, INCORPORATED
Subdivision Name
EXCELTH, INC., HEALTH CARE NETWORK
Type
HRSA-Funded Health Center
340B ID
CH062870
Entity Address
1515 Poydras St
New Orleans, LA 70112-3723
Grant Number
H80CS00129
Participating Start Date
12/1/1992
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY # 1439
Pharmacy Address
9701 CHEF MENTEUR HWY
NEW ORLEANS, LA 70127
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL A. ANDRY, CEO
(504) 524-1210 Ext: 4123
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
10/15/2018
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