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BROWN'S PHARMACY LLC
HV067570 CAPITOL CITY FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
CAPITOL CITY FAMILY HEALTH CENTER, INC.
Subdivision Name
ADMINISTRATIVE OFFICE
Type
Ryan White Part C
340B ID
HV067570
Entity Address
3140 FLORIDA STREET
BATON ROUGE, LA 70806
Grant Number
H76HA00817
Participating Start Date
10/1/2004
Last Recertification Date
3/10/2016
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
BROWN'S PHARMACY LLC
Pharmacy Address
1718 N FOSTER DR STE B
BATON ROUGE, LA 70806-1076
Pharmacy Comments
Contract Details
Approval Date
10/27/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
Yakima Black, Chief Executive Officer
(225) 650-2026
Contract Pharmacy Representative
Darlene S. Brown, Pharmacist in Charge
(225) 650-2077
Signed By Date
10/27/2014
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