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WALGREEN LOUISIANA CO., INC.
RWII70601 Southwest Louisiana AIDS Council
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Covered Entity Details
Entity Name
Southwest Louisiana AIDS Council
Subdivision Name
Type
Ryan White Part B
340B ID
RWII70601
Entity Address
425 Kingsley Street
Lake Charles, LA 70601
Grant Number
X07HA00018
Participating Start Date
4/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN LOUISIANA CO., INC.
Pharmacy Address
DBA: WALGREENS #10537
916 N. PINE ST.
DERIDDER, LA 70634-2816
Pharmacy Comments
Contract Details
Approval Date
7/20/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terry L. Estes, Executive Director
(337) 439-5861
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/20/2017
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