340B Drug Pricing Program Database
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DSH190317P OLH-Shreveport-St. Mary Medical Ctr (Active)
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Main Details
Name
OLH-Shreveport-St. Mary Medical Ctr
Subdivision Name
RU Urology Clinic LSMC BK05 - OLSC 255BK UROLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190317P
Medicare Provider Number
190317
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/25/2023
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Ochsner LSU St. Mary Medical Center
Riley Waddell, CEO
(318) 626-4139
Primary Contact
Ochsner LSU Health Shreveport - St Mary Medical Center
Emma Braddock, Manager - Pharmacy
(318) 626-2484
Addresses
Street Address
255 Bert Kouns Industrial Loop
Shreveport, LA 71106
Billing Address
OLH-SHREVEPORT-ST. MARY MEDICAL CTR
911 Margaret Place
Shreveport, LA 71101
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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