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RRC190041-09 CHRISTUS Shreveport-Bossier Health System (Terminated)
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Main Details
Name
CHRISTUS Shreveport-Bossier Health System
Subdivision Name
CHRISTUS HEALTH SHREVEPORT-BOSSIER - CHRISTUS OUTPATIENT THERAPY Bossier City
Type
Rural Referral Center
Rural
No
340B ID
RRC190041-09
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
4187 Viking Dr
Bossier City, LA 71111
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
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