Contract Pharmacy Details

UNIVERSITY HOSPITAL & CLINICS, INC.
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

UNIVERSITY HOSPITAL & CLINICS, INC.

Pharmacy Address

OUTPATIENT PHARMACY
2390 W CONGRESS ST
LAFAYETTE, LA 70506-4205

Pharmacy Comments

Contract Details

Approval Date

4/4/2014

Contract Begin Date

4/7/2014

Carve-In Effective Date

Contract Comments

04/07/2014 Immediate start date authorized due to ownership change of existing and active contract pharmacy arrangement

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

Debbie Benoit, Outpatient Pharmacy Director
(337) 266-4869

Signed By Date

4/4/2014

340B Drug Pricing Program Database