Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
RWI708062A Capitol City Family Health Center

Covered Entity Details

Entity Name

Capitol City Family Health Center

Subdivision Name

Type

Ryan White Part A

340B ID

RWI708062A

Entity Address

3140 Florida Blvd
Baton Rouge, LA 70806

Grant Number

H89HA11432

Participating Start Date

7/1/2024

Last Recertification Date

3/9/2025

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

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

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

4/17/2017

340B Drug Pricing Program Database