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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
DSH190098 University Health Shreveport, LLC
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Covered Entity Details
Entity Name
University Health Shreveport, LLC
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH190098
Entity Address
1541 KINGS HIGHWAY
SHREVEPORT, LA 71103
Medicare Provider Number
190098
Participating Start Date
1/1/1998
Last Recertification Date
9/6/2024
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
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vernon Moore, Chief Financial Officer
(318) 626-0990
Contract Pharmacy Representative
Reliant Healthcare
Brad Smith, CEO
(318) 322-8326
Signed By Date
4/19/2021
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