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LAGNIAPPE PHARMACY 8
STD705171 Cardiovascular Institute of the South
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Covered Entity Details
Entity Name
Cardiovascular Institute of the South
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD705171
Entity Address
1451 East Bridge Street
Breaux Bridge, LA 70517
Grant Number
NH25PS005176
Participating Start Date
4/1/2025
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
LAGNIAPPE PHARMACY 8
Pharmacy Address
1772 CANAL BLVD
THIBODAUX, LA 70301
Pharmacy Comments
Contract Details
Approval Date
2/12/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Hebert, CEO
(985) 873-5670
Contract Pharmacy Representative
Lagniappe Pharmacy
Eric Peters, CEO
(225) 810-7778
Signed By Date
1/15/2025
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