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HIGHLAND CLINIC PHARMACY
DSH190041 CHRISTUS Shreveport-Bossier Health System
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Covered Entity Details
Entity Name
CHRISTUS Shreveport-Bossier Health System
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190041
Entity Address
1453 E. Bert Kouns Industrial Loop
Shreveport, LA 71105
Medicare Provider Number
190041
Participating Start Date
7/1/2024
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
HIGHLAND CLINIC PHARMACY
Pharmacy Address
1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT, LA 71105
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Isaac Palmer, CEO
(318) 681-5729
Contract Pharmacy Representative
Christus Shreveport-Bossier
Raaed Hasan, Pharmacy Manager
(318) 798-4500
Signed By Date
4/15/2019
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