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KENTWOOD FAMILY PHARMACY LLC
CH06371E SOUTHEAST COMMUNITY HEALTH SYSTEMS
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Covered Entity Details
Entity Name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Subdivision Name
Southeast Community Health Systems- Kentwood Location
Type
HRSA-Funded Health Center
340B ID
CH06371E
Entity Address
721 Avenue G
Kentwood, LA 70444-2601
Grant Number
H80CS00370
Participating Start Date
7/1/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
KENTWOOD FAMILY PHARMACY LLC
Pharmacy Address
706 AVENUE G
KENTWOOD, LA 70444
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alecia Cyprian, Chief Executive Officer
(225) 306-2010
Contract Pharmacy Representative
phamacy
Dana Antoon, Owner
(225) 222-4279
Signed By Date
10/9/2023
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