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INVERNESS APOTHECARY TRINITY
RW428852 Southwest Louisiana AIDS Council
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Covered Entity Details
Entity Name
Southwest Louisiana AIDS Council
Subdivision Name
Type
Ryan White Part D
340B ID
RW428852
Entity Address
425 Kingsley Street
Lake Charles, LA 70601
Grant Number
H12HA28852
Participating Start Date
10/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
INVERNESS APOTHECARY TRINITY
Pharmacy Address
24333 GORDON TERRY PARKWAY
SUITE B
TRINITY, AL 35673
Pharmacy Comments
Contract Details
Approval Date
4/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry L. Estes, Executive Director
(337) 439-5861
Contract Pharmacy Representative
VitalRx
Bobby Wamble, COO
(256) 260-3350
Signed By Date
4/4/2018
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