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DSH190041C CHRISTUS Shreveport-Bossier Health System (Active)
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Main Details
Name
CHRISTUS Shreveport-Bossier Health System
Subdivision Name
CHRISTUS Wound and Hyperbaric Medicine Center - Shreveport-Bossier
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190041C
Medicare Provider Number
190041
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/29/2024
Last Recertification Date
8/16/2024
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
1505 East Bert Kouns Industrial Loop
Suite 101
Shreveport, LA 71105
Billing Address
CHRISTUS Health Shreveport-Bossier
1453 East Bert Kouns Industrial Loop
Shreveport, LA 71105
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (01/01/2018) until terminated effective date: (10/01/2023); reinstatement effective date: (07/1/2024)
04/24/2024
Participated starting 10/1/2012, terminated 1/1/2017. Reinstated 1/1/2018.
11/21/2017
May 2025
May 2025
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