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EXPRESS SCRIPTS SPECIALTY
STD706012 Southwest Louisiana AIDS Council
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Covered Entity Details
Entity Name
Southwest Louisiana AIDS Council
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD706012
Entity Address
425 Kingsley Street
Lake Charles, LA 70601
Grant Number
NH25PS005176
Participating Start Date
10/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS SPECIALTY
Pharmacy Address
DISTRIBUTION SERVICES INC
4600 N HANLEY RD STE B
SAINT LOUIS, MO 63134-2715
Pharmacy Comments
Contract Details
Approval Date
9/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry L. Estes, Executive Director
(337) 439-5861
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/12/2023
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