Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190034 ABBEVILLE GENERAL HOSPITAL

Covered Entity Details

Entity Name

ABBEVILLE GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190034

Entity Address

118 NORTH HOSPITAL DRIVE
ABBEVILLE, LA 70510

Medicare Provider Number

190034

Participating Start Date

9/15/2005

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

1/5/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ray Landry, CEO
(337) 898-6500

Contract Pharmacy Representative

RELIANT MEDICAL LLC
J Peter Guerriero, VP of Operations
(318) 322-8326

Signed By Date

1/5/2021

340B Drug Pricing Program Database