Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190054 IBERIA MEDICAL CENTER

Covered Entity Details

Entity Name

IBERIA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190054

Entity Address

2315 EAST MAIN STREET
NEW IBERIA, LA 70560

Medicare Provider Number

190054

Participating Start Date

7/1/2004

Last Recertification Date

9/6/2024

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

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dionne E Viator, CFO
(337) 374-7107

Contract Pharmacy Representative

Reliant
Clint Wood, Director 340B
(877) 354-2688

Signed By Date

7/15/2020

340B Drug Pricing Program Database