Contract Pharmacy Details

MOSS MEMORIAL CLINIC PHARMACY
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

MOSS MEMORIAL CLINIC PHARMACY

Pharmacy Address

1000 Walters St
Lake Charles, LA 70607

Pharmacy Comments

Contract Details

Approval Date

3/25/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

Colleen Higgs, Pharmacist
(510) 587-2605

Signed By Date

3/25/2014

340B Drug Pricing Program Database