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WALGREEN LOUISIANA CO., INC.
CH061920 DAVID RAINES COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Subdivision Name
DAVID RAINES COMMUNITY HEALTH CENTER, INC. - Shreveport
Type
HRSA-Funded Health Center
340B ID
CH061920
Entity Address
1625 David Raines Rd
Shreveport, LA 71107-5899
Grant Number
H80CS00720
Participating Start Date
10/1/2003
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 04998
9209 MANSFIELD RD.
SHREVEPORT, LA 71118
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Willie C. White III, CEO
(318) 227-3349 Ext: 3160
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2015
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