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Brothers Pharmacy LLC
STD700723 Harris M. Blackman, MD, LLC
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Covered Entity Details
Entity Name
Harris M. Blackman, MD, LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD700723
Entity Address
1111 Medical Center Boulevard
N-401
Marrero, LA 70072
Grant Number
NU62PS924522
Participating Start Date
4/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
Brothers Pharmacy LLC
Pharmacy Address
6200 Leslie Lane
Lake Charles, LA 70615-4772
Pharmacy Comments
Contract Details
Approval Date
6/7/2023
Contract Begin Date
6/7/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Ladd Bowman, Office Manager
(504) 347-2141 Ext: 1
Contract Pharmacy Representative
Brothers Pharmacy
Bill Tella, Chief Business Officer
(516) 532-2469
Signed By Date
6/7/2023
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