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BRFHH MONROE LLC
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
BRFHH MONROE LLC
Pharmacy Address
OCHSNER LSU HEALTH MONROE OUTPATIENT PHA
4864 JACKSON ST RM 1-161B
MONROE, LA 71202
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pat Keel, Chief Financial Officer
(318) 675-4864
Contract Pharmacy Representative
DHS190011
LORETTA LEMOINE, DIRECTOR OF PHARMACY
(318) 330-7969
Signed By Date
10/15/2014
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