Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
CAH191304-00 NORTH CADDO MEDICAL CENTER

Covered Entity Details

Entity Name

NORTH CADDO MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH191304-00

Entity Address

815 South Pine
VIVIAN, LA 71082

Medicare Provider Number

191304

Participating Start Date

7/1/2016

Last Recertification Date

8/14/2024

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

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Jones, CEO
(318) 375-4001

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database