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Brothers Pharmacy LLC
STD70605 The Arthritis Center of Southwest Louisiana
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Covered Entity Details
Entity Name
The Arthritis Center of Southwest Louisiana
Subdivision Name
The Arthritis Center of Southwest Louisiana
Type
Sexually Transmitted Diseases
340B ID
STD70605
Entity Address
1727 Imperial Blvd
bldg 1b
Lake Charles, LA 70605
Grant Number
NH25PS005176
Participating Start Date
4/1/2024
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
Brothers Pharmacy LLC
Pharmacy Address
6200 Leslie Lane
Lake Charles, LA 70615-4772
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timeko West, Practice Manager
(337) 936-0690
Contract Pharmacy Representative
Pharmacy
Troy Tate, President
(800) 291-1089
Signed By Date
7/11/2024
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