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WALGREEN LOUISIANA CO., INC.
CH062350 IBERIA COMPRHESIVE COM HEALTH CNTR, INC.
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Covered Entity Details
Entity Name
IBERIA COMPRHESIVE COM HEALTH CNTR, INC.
Subdivision Name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH062350
Entity Address
806 Jefferson Ter
New Iberia, LA 70560-5727
Grant Number
H80CS00697
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 07696
1401 REES STREET
BREAUX BRIDGE, LA 70517-4307
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RODERICK C. CAMPBELL, CEO
(337) 365-4945 Ext: 128
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2013
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