Contract Pharmacy Details

RELIANT HEALTHCARE
CHC28962-00 HIV/AIDS ALLIANCE FOR REGION TWO, INC.

Covered Entity Details

Entity Name

HIV/AIDS ALLIANCE FOR REGION TWO, INC.

Subdivision Name

North Blvd Clinic

Type

HRSA-Funded Health Center

340B ID

CHC28962-00

Entity Address

3801 North Blvd.
BATON ROUGE, LA 70806

Grant Number

H80CS28962

Participating Start Date

4/1/2016

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

RELIANT HEALTHCARE

Pharmacy Address

RELIANT MEDICAL LLC
4315 TEXAS BLVD
TEXARKANA, TX 75503

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Timothy Young, CEO
(225) 424-1800

Contract Pharmacy Representative

Reliant Healthcare
BRAD SMITH, CEO
(318) 322-8326

Signed By Date

4/12/2019

340B Drug Pricing Program Database