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ELLIOTT PHARMACY #3
CH0610680 INNIS COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
INNIS COMMUNITY HEALTH CENTER, INC.
Subdivision Name
INNIS COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0610680
Entity Address
6450 LA HIGHWAY 1 STE B
INNIS, LA 70747-0889
Grant Number
H80CS00855
Participating Start Date
1/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
ELLIOTT PHARMACY #3
Pharmacy Address
169 E MAIN STREET
NEW ROADS, LA 70760
Pharmacy Comments
Contract Details
Approval Date
8/8/2007
Contract Begin Date
8/8/2007
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
7/18/2007
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