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WAL-MART PHARMACY 10-0542
FQHCLA435 LIFE COAST COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
LIFE COAST COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Life Coast Community Health Center Houma
Type
Health Center Program Look-Alike
340B ID
FQHCLA435
Entity Address
605 Enterprise Drive Suite C
Houma, LA 70360-5405
Grant Number
LALCS47057
Participating Start Date
10/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0542
Pharmacy Address
1633 MARTIN LUTHER KING BLVD
HOUMA, LA 70360
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shannon Boudreaux, CEO
(985) 492-6170
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/11/2024
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