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WALGREEN LOUISIANA CO., INC.
STD70508 Lafayette Foundation Clinic INC
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Covered Entity Details
Entity Name
Lafayette Foundation Clinic INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70508
Entity Address
117 Caillouet Place
Lafayette, LA 70501
Grant Number
NH25PS005176
Participating Start Date
4/1/2020
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 05747
3747 MOSS STREET
LAFAYETTE, LA 70507
Pharmacy Comments
Contract Details
Approval Date
7/2/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Jason Landry, Founder
(337) 988-9737
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/2/2020
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