Contract Pharmacy Details

WINN DIXIE MONTGOMERY, LLC.
RWIID70112 STD/HIV Program

Covered Entity Details

Entity Name

STD/HIV Program

Subdivision Name

OFFICE OF PUBLIC HEALTH

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID70112

Entity Address

1450 POYDRAS ST.
Suite 2136
NEW ORLEANS, LA 70112

Grant Number

X07HA00018

Participating Start Date

7/1/1998

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WINN DIXIE MONTGOMERY, LLC.

Pharmacy Address

WINN DIXIE PHARMACY #1453
6800 GREENWELL SPRINGS RD.
BATON ROUGE, LA 70805

Pharmacy Comments

Contract Details

Approval Date

10/9/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/19/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

John Fegan, VP, Pharmacy
(904) 783-5000

Signed By Date

10/9/2013

340B Drug Pricing Program Database