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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190116A MOREHOUSE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MOREHOUSE GENERAL HOSPITAL
Subdivision Name
MOREHOUSE RURAL HEALTH CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH190116A
Entity Address
420 GUNBY STREET
BASTROP, LA 71220-4406
Medicare Provider Number
190116
Outpatient Facility Provider Number
193487
Participating Start Date
4/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
Pharmacy Address
1004 N 19TH ST
MONROE, LA 71201-5734
Pharmacy Comments
11/15/10 UPDATED ADDR (WAS 300 N. STANLEY);
Contract Details
Approval Date
7/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/20/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Derrick Frazier, Chief Executive Officer
(318) 283-3601
Contract Pharmacy Representative
Reliant Healthcare
Brad Smith, CEO
(318) 322-8326
Signed By Date
7/17/2019
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