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ACCREDO HEALTH GROUP, INC.
STD704331 Baldone Reina Dermatology
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Covered Entity Details
Entity Name
Baldone Reina Dermatology
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD704331
Entity Address
150Lakeview Circle
Covington, LA 70433
Grant Number
NU62PS924522
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie C Moga, Office Manager
(985) 892-3376
Contract Pharmacy Representative
Accredo
Travis Behrens, Managing Director
(314) 486-5839
Signed By Date
10/15/2024
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