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WINN DIXIE PHARMACY #1472
RWI70119B 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
CrescentCare Mid-City
Type
Ryan White Part A
340B ID
RWI70119B
Entity Address
2515 Canal Street
New Orleans, LA 70119
Grant Number
H89HA00035
Participating Start Date
1/1/2015
Last Recertification Date
3/7/2025
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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