Contract Pharmacy Details

WINN DIXIE MONTGOMERY, LLC.
CH061335A ST. CHARLES COMMUNITY HEALTH CENTER, INC.

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

WINN DIXIE MONTGOMERY, LLC.

Pharmacy Address

WINN DIXIE PHARMACY # 1444
12125 HWY 90
LULING, LA 70070

Pharmacy Comments

Contract Details

Approval Date

4/16/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/29/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

MARK F. KEISER, CEO
(504) 575-3746

Contract Pharmacy Representative

SE Grocers
Scott Wink, Director, Pharmacy Managed Care
(904) 370-7776

Signed By Date

4/16/2016

340B Drug Pricing Program Database