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LOUISIANA CVS PHARMACY, L.L.C.
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
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05326
2755 HOLLYWOOD AVE
SHREVEPORT, LA 71108
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Randolph, President
(318) 626-0982
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2016
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