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BROTHER'S PHARMACY
STD706051 Shondra L. Smith MD Dermatology and Advanced Aesthetics
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Covered Entity Details
Entity Name
Shondra L. Smith MD Dermatology and Advanced Aesthetics
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD706051
Entity Address
3635 Nelson Road
Lake Charles, LA 70605
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
BROTHER'S PHARMACY
Pharmacy Address
BROTHER'S PHARMACY LLC
6200 LESLIE LN
LAKE CHARLES, LA 70615
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
Cindi Reed, Practice Manager
(337) 477-0011
Contract Pharmacy Representative
Pharmacy
Troy Tate, President
(800) 291-1089
Signed By Date
7/15/2024
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