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BROTHER'S PHARMACY
CH063380 SWLA CENTER FOR HEALTH SERVICES
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Covered Entity Details
Entity Name
SWLA CENTER FOR HEALTH SERVICES
Subdivision Name
SOUTHWEST LOUISIANA CENTER FOR HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH063380
Entity Address
2000 Opelousas St
Lake Charles, LA 70601-2641
Grant Number
H80CS00558
Participating Start Date
10/1/2002
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
BROTHER'S PHARMACY
Pharmacy Address
BROTHER'S PHARMACY LLC
6200 LESLIE LN
LAKE CHARLES, LA 70615
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Ng, CFO
(337) 488-8008
Contract Pharmacy Representative
Pharmacy
Troy Tate, President
(800) 291-1089
Signed By Date
10/12/2023
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