340B Drug Pricing Program Database
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DSH190098AQ University Health Shreveport, LLC (Active)
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Main Details
Name
University Health Shreveport, LLC
Subdivision Name
MPP Gastro OLSP FA01 / MPP - Gastro Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190098AQ
Medicare Provider Number
190098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/30/2020
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Ochsner LSU
Christopher Eric Mangin, CEO
(318) 205-2245
Primary Contact
BRFHH Shreveport LLC
Jason D Lafitte, Director of Pharmacy
(318) 626-0863
Addresses
Street Address
1801 FAIRFIELD AVE
STE 305
SHREVEPORT, LA 71101-4467
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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