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DSH190041AM CHRISTUS Shreveport-Bossier Health System (Active)
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Main Details
Name
CHRISTUS Shreveport-Bossier Health System
Subdivision Name
CHRISTUS Cardiac Rehab Shreveport
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190041AM
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
9425 Healthplex Drive
Suite D
Shreveport, LA 71106
Billing Address
CHRISTUS Health Shreveport-Bossier
1453 E. Bert Kouns Industrial Loop
Shreveport, LA 71105
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/01/2018) until terminated effective date: (10/01/2023); reinstatement effective date: (07/1/2024)
04/25/2024
May 2025
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