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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
CH06757C CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
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Covered Entity Details
Entity Name
CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
Subdivision Name
Capitol City Family Health Center- Plaquemine (Iberville Parish)
Type
HRSA-Funded Health Center
340B ID
CH06757C
Entity Address
59340 River West Drive
Plaquemine, LA 70764
Grant Number
H80CS00504
Participating Start Date
1/1/2015
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
Pharmacy Address
1004 N 19TH ST
MONROE, LA 71201-5734
Pharmacy Comments
11/15/10 UPDATED ADDR (WAS 300 N. STANLEY);
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Valliere, Chief Executive Officer
(225) 650-2026
Contract Pharmacy Representative
Reliant Healthcare
BRAD SMITH, CEO
(318) 322-8326
Signed By Date
4/13/2016
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