Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190116 MOREHOUSE GENERAL HOSPITAL

Covered Entity Details

Entity Name

MOREHOUSE GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190116

Entity Address

323 WEST WALNUT
BASTROP, LA 71220

Medicare Provider Number

190116

Participating Start Date

1/1/2005

Last Recertification Date

8/19/2024

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

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

340B Drug Pricing Program Database