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WALGREEN LOUISIANA CO., INC.
STD70508 Lafayette Foundation Clinic INC
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Covered Entity Details
Entity Name
Lafayette Foundation Clinic INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70508
Entity Address
117 Caillouet Place
Lafayette, LA 70501
Grant Number
NH25PS005176
Participating Start Date
4/1/2020
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS # 02262
1100 ELYSIAN FIELDS
NEW ORLEANS, LA 70117
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Landry, Medical Director
(337) 988-9737
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2023
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