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LOUIS LEONARD MINSKY INC
STD712541 Lake Providence Medical Clinic
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Covered Entity Details
Entity Name
Lake Providence Medical Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD712541
Entity Address
319 N. Hood Street
Lake Providence, LA 71254
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
LOUIS LEONARD MINSKY INC
Pharmacy Address
DBA MINSKYS DRUG STORE
405 LAKE ST
LAKE PROVIDENCE, LA 71254
Pharmacy Comments
Contract Details
Approval Date
8/7/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amanda D Grey, COO
(318) 428-3237
Contract Pharmacy Representative
Minsky's Drug Store
Catherine Coon, Pharmacist
(318) 559-2400
Signed By Date
7/12/2024
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