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ACCREDO HEALTH GROUP, INC.
STD71111 Gastrointestinal Specialists AMC
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Covered Entity Details
Entity Name
Gastrointestinal Specialists AMC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD71111
Entity Address
2400 Hospital Drive
Suite 370
Bossier City, LA 71111
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
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
Accredo
Travis Behrens, Managing Director
(314) 486-5839
Signed By Date
7/15/2024
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