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DSH190041AN CHRISTUS Shreveport-Bossier Health System (Active)
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Main Details
Name
CHRISTUS Shreveport-Bossier Health System
Subdivision Name
CHRISTUS Bossier Emergency Hospital - Emergency Room
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190041AN
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
2531 Viking Drive
Bossier City, LA 71111
Billing Address
CHRISTUS Shreveport-Bossier Health System
1453 E. Bert Kouns Industrial Loop
SHREVEPORT, TX 71105-3577
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2019) until terminated effective date: (10/01/2023); reinstatement effective date: (07/1/2024)
04/25/2024
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