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PROCARE PHARMACY, L.L.C.
FQHCLA435 LIFE COAST COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
LIFE COAST COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Life Coast Community Health Center Houma
Type
Health Center Program Look-Alike
340B ID
FQHCLA435
Entity Address
605 Enterprise Drive Suite C
Houma, LA 70360-5405
Grant Number
LALCS47057
Participating Start Date
10/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
4/8/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shannon Boudreaux, CEO
(985) 492-6170
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2025
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