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HEALTH MART PHARMACY OF LAFAYETTE
STD70508 Lafayette Foundation Clinic INC
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Covered Entity Details
Entity Name
Lafayette Foundation Clinic INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70508
Entity Address
117 Caillouet Place
Lafayette, LA 70501
Grant Number
NH25PS005176
Participating Start Date
4/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HEALTH MART PHARMACY OF LAFAYETTE
Pharmacy Address
600 JOHNSTON ST
LAFAYETTE, LA 70501-8060
Pharmacy Comments
Contract Details
Approval Date
3/5/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason D Landry, Dr
(337) 988-9737 Ext: 3373229616
Contract Pharmacy Representative
Health Mart of Lafayette
Kitty L Trahan, COO
(337) 230-1567
Signed By Date
1/10/2020
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