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WINN DIXIE PHARMACY #1472
STD701162 NO/AIDS Task Force (d.b.a. CrescentCare)
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Covered Entity Details
Entity Name
NO/AIDS Task Force (d.b.a. CrescentCare)
Subdivision Name
Prevention
Type
Sexually Transmitted Diseases
340B ID
STD701162
Entity Address
1631 ELYSIAN FIELDS AVE
New Orleans, LA 70117
Grant Number
H25PS005176
Participating Start Date
10/1/2013
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY #1472
Pharmacy Address
401 N. CARROLLTON AVE.
NEW ORLEANS, LA 70119-4702
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Ownership change
Contacts
Covered Entity Signing Official
NOEL John TWILBECK, CEO
(504) 821-2601 Ext: 1000
Contract Pharmacy Representative
Southeastern Grocers LLC
Michael LeBlanc, Sr.Director, Pharmacy
(904) 783-5897
Signed By Date
4/12/2022
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