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RIVER MEDICAL PHARMACY LLC
STD706051 Shondra L. Smith MD Dermatology and Advanced Aesthetics
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Covered Entity Details
Entity Name
Shondra L. Smith MD Dermatology and Advanced Aesthetics
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD706051
Entity Address
3635 Nelson Road
Lake Charles, LA 70605
Grant Number
NU62PS924522
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
RIVER MEDICAL PHARMACY LLC
Pharmacy Address
4752 RESEARCH DR
SAN ANTONIO, TX 78240-5002
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cindi Reed, Practice Manager
(337) 477-0011
Contract Pharmacy Representative
BioPlus
Jeremy Richardson, Vice President of Strategy & Commercial Growth
(317) 730-7705
Signed By Date
4/14/2025
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