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CAREMARK KANSAS SPECIALTY PHARMACY
STD74381 Northlake Gastroenterology Associates LLP
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Covered Entity Details
Entity Name
Northlake Gastroenterology Associates LLP
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD74381
Entity Address
809 Boat Ramp Rd
Franklinton, LA 70438
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
CAREMARK KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Martin Leahy, Manager
(985) 542-1334
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2025
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