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DESTREHAN PHARMACY INC.
CH061335A ST. CHARLES COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
ST. CHARLES COMMUNITY HEALTH CENTER, INC.
Subdivision Name
ST. CHARLES COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH061335A
Entity Address
843 Milling Ave
Luling, LA 70070-4442
Grant Number
H80CS00867
Participating Start Date
10/1/2003
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
DESTREHAN PHARMACY INC.
Pharmacy Address
12627 AIRLINE HWY
DESTREHAN, LA 70047
Pharmacy Comments
Contract Details
Approval Date
10/2/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
MARK F. KEISER, CEO
(504) 575-3746
Contract Pharmacy Representative
Bruce Burkenstock Jr., Owner
(985) 764-1181
Signed By Date
10/2/2014
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