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HEALTH MART PHARMACY OF LAFAYETTE
STD705032 Louisiana Gastroenterology Associates, LLC
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Covered Entity Details
Entity Name
Louisiana Gastroenterology Associates, LLC
Subdivision Name
Louisiana Gastroenterology Associates, LLC
Type
Sexually Transmitted Diseases
340B ID
STD705032
Entity Address
1211 Coolidge Blvd Ste 400
Lafayette, LA 70503
Grant Number
NU62PS924522
Participating Start Date
7/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
HEALTH MART PHARMACY OF LAFAYETTE
Pharmacy Address
600 JOHNSTON ST
LAFAYETTE, LA 70501-8060
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maneesh Gupta, CEO
(337) 322-2147
Contract Pharmacy Representative
Health Mart of Lafayette
Kitty L Trahan, COO
(337) 230-1567
Signed By Date
10/4/2023
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