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VAN MOL FAMILY PHARMACY, LLC
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
VAN MOL FAMILY PHARMACY, LLC
Pharmacy Address
9374 HWY 165 S
WOODWORTH, LA 71485
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK F. KEISER, CEO
(504) 575-3746
Contract Pharmacy Representative
Sincere Rx
Peter Saad, President
(681) 238-2860
Signed By Date
1/15/2016
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