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LOUISIANA CVS PHARMACY, L.L.C.
CH061335A ST. CHARLES COMMUNITY HEALTH CENTER, INC.
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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
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05276
721 BOLTON AVE
ALEXANDRIA, LA 71301
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
MARK F. KEISER, CEO
(504) 575-3746
Contract Pharmacy Representative
CVS
Lisa Chaykowski, National Sales Executive
(214) 918-6261
Signed By Date
7/14/2021
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