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PROPRIUM SOLUTIONS L.L.C
STD71115 Gastrointestinal Specialists AMC
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Covered Entity Details
Entity Name
Gastrointestinal Specialists AMC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD71115
Entity Address
8383 Millicent Way
Suite B
Shreveport, LA 71115
Grant Number
NU62PS924522
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
PROPRIUM SOLUTIONS L.L.C
Pharmacy Address
3710 YOUREE DR
SHREVEPORT, LA 71105
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
Adi Darsi, CEO
(318) 213-4536
Contract Pharmacy Representative
Proprium
Jana Treece, PIC
(318) 841-6416
Signed By Date
7/15/2024
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