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SCPG LOUISIANA LLC
STD712631 Community Medical Clinic
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Covered Entity Details
Entity Name
Community Medical Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD712631
Entity Address
712 Settoon Street
Oak Grove, LA 71263
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
SCPG LOUISIANA LLC
Pharmacy Address
DBA: EXPRESS RX OF LAKE PROVIDENCE
302 LAKE STREET
LAKE PROVIDENCE, LA 71254
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
10/17/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amanda D Grey, COO
(318) 428-3237
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
10/15/2024
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