Contract Pharmacy Details

KINGS 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

KINGS PHARMACY

Pharmacy Address

3102 LINWOOD AVE
SHREVEPORT, LA 71103-4231

Pharmacy Comments

Contract Details

Approval Date

10/10/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

Zyed Zulfiqar, Director
(214) 331-4500

Signed By Date

10/10/2014