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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190011 BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
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Covered Entity Details
Entity Name
BRFHH Monroe LLC d/b/a Ochsner LSU Health Monroe
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190011
Entity Address
4864 JACKSON STREET
MONROE, LA 71202
Medicare Provider Number
190011
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
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
4/7/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark A Randolph, CEO
(318) 584-2569
Contract Pharmacy Representative
Reliant Healthcare
Brad Smith, CEO
(318) 322-8326
Signed By Date
4/7/2021
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