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WALGREEN LOUISIANA CO., INC.
CHC26580-01 Common Ground Health Clinic
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Covered Entity Details
Entity Name
Common Ground Health Clinic
Subdivision Name
CGHC-Wall Blvd
Type
HRSA-Funded Health Center
340B ID
CHC26580-01
Entity Address
441 Wall Blvd
Gretna, LA 70056-7723
Grant Number
H80CS26580
Participating Start Date
1/1/2019
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS SPECIALTY PHARMACY #15198
1111 MEDICAL CENTER BLVD STE 116N
MARRERO, LA 70072
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carleetha Smith, CEO
(504) 361-9800
Contract Pharmacy Representative
Walgreen Co
Christine Fullmer, Client Relationship Analyst
(847) 315-5300
Signed By Date
1/14/2020
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