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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
RWII71104 PHILADELPHIA CENTER
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Covered Entity Details
Entity Name
PHILADELPHIA CENTER
Subdivision Name
Type
Ryan White Part B
340B ID
RWII71104
Entity Address
2020 CENTENARY BOULEVARD
SHREVEPORT, LA 71104
Grant Number
X07HA00018
Participating Start Date
7/1/2004
Last Recertification Date
2/10/2025
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
11/15/2010
Contract Begin Date
11/15/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/11/2010
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