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LOUISIANA CVS PHARMACY, L.L.C.
STD708091 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Baton Rouge (Azmeh)
Type
Sexually Transmitted Diseases
340B ID
STD708091
Entity Address
4890 Bluebonnet Blvd.
Baton Rouge, LA 70809-9649
Grant Number
NH25PS005176
Participating Start Date
7/13/2020
Last Recertification Date
5/21/2024
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05510
11705 COURSEY BLVD.
BATON ROUGE, LA 70816
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2022
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