340B Drug Pricing Program Database
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DSH190098E University Health Shreveport, LLC (Terminated)
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Main Details
Name
University Health Shreveport, LLC
Subdivision Name
Ochsner LSU Health Shreveport/Diabetic and Wound Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190098E
Medicare Provider Number
190098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/17/2013
Last Recertification Date
9/14/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Ochsner LSU Health Shreveport
Vernon Moore, Chief Financial Officer
(318) 626-0990
Primary Contact
BRFHH Shreveport LLC
Jason D Lafitte, Director of Pharmacy
(318) 626-0863
Addresses
Street Address
1606 Kings Highway
Shreveport, LA 71103
Billing Address
Ochsner LSU Health Shreveport
1541 Kings Highway
Shreveport, LA 71103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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