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Walgreens #21373
CH063380 SWLA CENTER FOR HEALTH SERVICES
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Covered Entity Details
Entity Name
SWLA CENTER FOR HEALTH SERVICES
Subdivision Name
SOUTHWEST LOUISIANA CENTER FOR HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH063380
Entity Address
2000 Opelousas St
Lake Charles, LA 70601-2641
Grant Number
H80CS00558
Participating Start Date
10/1/2002
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
7/6/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Ng, CFO
(337) 488-8008
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2022
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