Contract Pharmacy Details

MIDCITY 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

MIDCITY PHARMACY

Pharmacy Address

1401 N FOSTER DR
BATON ROUGE, LA 70806-1818

Pharmacy Comments

Contract Details

Approval Date

4/13/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DeAnn Gruber, Administrative Director Louisiana OPH STD/HIV Program
(504) 568-7474

Contract Pharmacy Representative

Our Lady of the Lake Regional Medical Center
Terrie Sterling, Chief Operating Officer
(225) 765-8927

Signed By Date

4/13/2018

340B Drug Pricing Program Database