Contract Pharmacy Details

Walgreens #21373
CHC28962-00 HIV/AIDS ALLIANCE FOR REGION TWO, INC.

Covered Entity Details

Entity Name

HIV/AIDS ALLIANCE FOR REGION TWO, INC.

Subdivision Name

North Blvd Clinic

Type

HRSA-Funded Health Center

340B ID

CHC28962-00

Entity Address

3801 North Blvd.
BATON ROUGE, LA 70806

Grant Number

H80CS28962

Participating Start Date

4/1/2016

Last Recertification Date

2/10/2025

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

7/14/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lyndon Darensbourg, CFO
(225) 424-1734

Contract Pharmacy Representative

Walgreens
Tony Joe Chriscoe, 340 Client Relations Analyst
(847) 315-5806

Signed By Date

7/14/2023

340B Drug Pricing Program Database