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WALGREEN LOUISIANA CO., INC.
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
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #12557
4550 GENERAL MEYER AVE
NEW ORLEANS, LA 70131
Pharmacy Comments
Contract Details
Approval Date
10/4/2012
Contract Begin Date
10/4/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL A. ANDRY, CEO
(504) 524-1210 Ext: 4123
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/25/2012
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