Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190002 LAFAYETTE GENERAL MEDICAL CENTER

Covered Entity Details

Entity Name

LAFAYETTE GENERAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190002

Entity Address

1214 COOLIDGE STREET
LAFAYETTE, LA 70503

Medicare Provider Number

190002

Participating Start Date

10/25/2005

Last Recertification Date

9/3/2024

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

4/1/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Agreement registered in error

Contacts

Covered Entity Signing Official

al jude patin, SVP, Chief Operating Officer
(337) 289-7743

Contract Pharmacy Representative

Reliant Healthcare
Brad Smith, CEO
(318) 322-8326

Signed By Date

4/1/2021

340B Drug Pricing Program Database