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KEN'S THRIFTY WAY PHARMACY
STD70577 Acadiana Practitioners LLC
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Covered Entity Details
Entity Name
Acadiana Practitioners LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70577
Entity Address
414 Saizan Ave
Port Barre, LA 70577
Grant Number
NH25PS005176
Participating Start Date
11/13/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
KEN'S THRIFTY WAY PHARMACY
Pharmacy Address
AND HOME MEDICAL-PORT BARRE
418 N SAIZON ST
PORT BARRE, LA 70577-5156
Pharmacy Comments
Contract Details
Approval Date
11/13/2024
Contract Begin Date
11/13/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Bergeron, CEO
(337) 447-4027
Contract Pharmacy Representative
Ken's Thrifty Way
Tammy Robert, Manager
(337) 942-8911
Signed By Date
10/15/2024
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