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DSH190098B BRFHH Shreveport LLC (Terminated)
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Main Details
Name
BRFHH Shreveport LLC
Subdivision Name
Endoscopy Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190098B
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
8/19/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Ochsner LSU Health Monroe
Mark A Randolph, CEO
(318) 584-2569
Primary Contact
Jason Lafitte, Director of Pharmacy
(318) 675-5248
Addresses
Street Address
1541 Kings Highway
Shreveport, LA 71103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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