Contract Pharmacy Details

RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190006 UNIVERSITY HOSPITAL AND CLINICS

Covered Entity Details

Entity Name

UNIVERSITY HOSPITAL AND CLINICS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190006

Entity Address

2390 W CONGRESS ST.
LAFAYETTE, LA 70506

Medicare Provider Number

190006

Participating Start Date

1/1/1998

Last Recertification Date

8/28/2024

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

4/6/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Katherine Hebert, Chief Executive Officer
(337) 261-6004

Contract Pharmacy Representative

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

Signed By Date

4/6/2021

340B Drug Pricing Program Database