Covered Entity Details

RRC190041-11 CHRISTUS Shreveport-Bossier Health System (Terminated) - information as of 5/28/2025 5:19:55 PM

Main Details

Name

CHRISTUS Shreveport-Bossier Health System

Subdivision Name

CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY STONEWALL

Type

Rural Referral Center

Rural

340B ID

RRC190041-11

Medicare Provider Number

190041

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/10/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/29/2024

Last Recertification Date

Termination Date
Termination Reason

1/1/2025
Other

Contacts

Authorizing Official

CHRISTUS St. Michael & Shreveport-Bossier Health Systems
Glen Boles, VP & Chief Financial Officer
(903) 614-2007

Primary Contact

CHRISTUS Shreveport-Bossier Health System
Lois Rose Anderson, Director of Pharmacy
(318) 681-7383

Addresses

Street Address

4974 HIGHWAY 3276
STE B
Stonewall, LA 71078

Billing Address

CHRISTUS Shreveport-Bossier Health System
1453 E. Bert Kouns Industrial Loop
SHREVEPORT, LA 71105

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
LA	1744379	1417950106
TX		1417950106

Shipping Addresses

Shipping Address 1

CHRISTUS Shreveport-Bossier Health System
1453 E. Bert Kouns Industrial Loop
SHREVEPORT, LA 71105

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC190041-01	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS CANCER TREATMENT CTR-BOSSI - Cancer Services	2539 VIKING DR	BOSSIER CITY	LA	Terminated
RRC190041-02	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS WOUND CARE AND HYPERBARIC - Wound Care and Hyperbaric Services	1505 E BERT KOUNS INDUSTRIAL LOOP	SHREVEPORT	LA	Terminated
RRC190041-03	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS BREAST CENTER SHREVEPORT-B - Radiology - Diagnostic	1505 E BERT KOUNS INDUSTRIAL LOOP	SHREVEPORT	LA	Terminated
RRC190041-04	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS CARDIAC REHAB SHREVEPORT - Cardiac Rehab	9425 HEALTHPLEX DR	SHREVEPORT	LA	Terminated
RRC190041-05	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS BOSSIER EMERGENCY HOSPITAL - Emergency Services	2531 VIKING DR	BOSSIER CITY	LA	Terminated
RRC190041-06	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS KIDS CLINIC SHREVEPORT-BOS - Physical Therapy	1700 BUCKNER ST	SHREVEPORT	LA	Terminated
RRC190041-07	Child	RRC	CHRISTUS Shreveport-Bossier Health System	ASHLEY RIDGE IMAGING CENTER - Imaging	463 ASHLEY RIDGE BLVD	SHREVEPORT	LA	Terminated
RRC190041-08	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS BOSSIER EMERGENCY HOSPITAL - Acute Medical/Surgical	2531 VIKING DR	BOSSIER CITY	LA	Terminated
RRC190041-09	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY Bossier City	4187 Viking Dr	Bossier City	LA	Terminated
RRC190041-10	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY Shreveport	8835 Line Ave	Shreveport	LA	Terminated
RRC190041-11	Child	RRC	CHRISTUS Shreveport-Bossier Health System	CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY STONEWALL	4974 HIGHWAY 3276	Stonewall	LA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2024 12:00:00 AM	11/22/2024 9:44 AM
Details	State	Update	Termination Request	Approved	To Be Terminated	11/22/2024 9:44 AM
Terminations	Termination Comments	Update	Termination Request		Location will be able to maintain DSH status and is terminating the RRC change and requests the DSH be reactivated.	11/22/2024 9:44 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	11/22/2024 9:44 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2024 12:00:00 AM	11/22/2024 9:44 AM
Terminations	Termination Reason	Update	Termination Request		Other	11/22/2024 9:44 AM
Details	Entity Name	Update	Change Request	HIGHLAND MEDICAL CENTER	CHRISTUS Shreveport-Bossier Health System	11/6/2024 1:25 PM
Contacts	Signed By	Insert	New Registration		Boles, Glen VP & Chief Financial Officer CHRISTUS St. Michael & Shreveport-Bossier Health Systems 9036142007	10/29/2024 8:26 AM
Details	340B ID	Update	New Registration		RRC190041-11	10/29/2024 8:26 AM
Details	Entity Subname	Update	New Registration	CHRISTUS HEALTH SHREVEPORT-BOSSIER	CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY STONEWALL	10/29/2024 8:26 AM
Dates	Participating Approval Date	Update	New Registration		10/29/2024 8:26:49 AM	10/29/2024 8:26 AM
Details	State	Update	New Registration	Pending	Approved	10/29/2024 8:26 AM
Dates	Signed By Date	Update	New Registration		10/10/2024 10:19:53 AM	10/29/2024 8:26 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/29/2024 8:26 AM
Addresses	Main Address	Insert	New Registration		4974 HIGHWAY 3276 STE B Stonewall, LA 71078	10/10/2024 10:19 AM
Addresses	Billing Address	Insert	New Registration		CHRISTUS Shreveport-Bossier Health System 1453 E. Bert Kouns Industrial Loop SHREVEPORT, LA 71105	10/10/2024 10:19 AM
Addresses	Shipping Address	Insert	New Registration		CHRISTUS Shreveport-Bossier Health System 1453 E. Bert Kouns Industrial Loop SHREVEPORT, LA 71105	10/10/2024 10:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2024 10:19 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1744379	10/10/2024 10:19 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	10/10/2024 10:19 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1417950106	10/10/2024 10:19 AM
Medicaid Billing	NPI: State	Insert	New Registration		LA	10/10/2024 10:19 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1417950106	10/10/2024 10:19 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	10/10/2024 10:19 AM
Contacts	Primary Contact	Insert	New Registration		Anderson, Lois Rose Director of Pharmacy CHRISTUS Shreveport-Bossier Health System 3186817383	10/10/2024 10:19 AM
Contacts	Authorizing Official	Insert	New Registration		Boles, Glen VP & Chief Financial Officer CHRISTUS St. Michael & Shreveport-Bossier Health Systems 9036142007	10/10/2024 10:19 AM
Details	Assistance Received From Date	Insert	New Registration			10/10/2024 10:19 AM
Details	Assistance Received To Date	Insert	New Registration			10/10/2024 10:19 AM
Details	Last Recertification Date	Insert	New Registration			10/10/2024 10:19 AM
Details	Grant Number	Insert	New Registration			10/10/2024 10:19 AM
Details	340B ID	Insert	New Registration			10/10/2024 10:19 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2024 10:19 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2024 10:19 AM
Details	Medicare Provider Number	Insert	New Registration		190041	10/10/2024 10:19 AM
Details	Entity Name	Insert	New Registration		HIGHLAND MEDICAL CENTER	10/10/2024 10:19 AM
Details	NOFO Number	Insert	New Registration			10/10/2024 10:19 AM
Details	Program Code	Insert	New Registration		RRC	10/10/2024 10:19 AM
Details	Entity Subname	Insert	New Registration		CHRISTUS HEALTH SHREVEPORT-BOSSIER	10/10/2024 10:19 AM
Dates	Participating Approval Date	Insert	New Registration			10/10/2024 10:19 AM
Details	State	Insert	New Registration		Pending	10/10/2024 10:19 AM
Dates	Registration Date	Insert	New Registration		10/10/2024 10:19:50 AM	10/10/2024 10:19 AM
Dates	Signed By Date	Insert	New Registration			10/10/2024 10:19 AM
Dates	Start Date	Insert	New Registration			10/10/2024 10:19 AM
Terminations	Termination Comments	Insert	New Registration			10/10/2024 10:19 AM
Terminations	Termination Date	Insert	New Registration			10/10/2024 10:19 AM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2024 10:19 AM
Terminations	Termination Reason	Insert	New Registration			10/10/2024 10:19 AM