Contract Pharmacy Details

BRFHH SHREVEPORT LLC
RWIID70112 STD/HIV Program

Covered Entity Details

Entity Name

STD/HIV Program

Subdivision Name

OFFICE OF PUBLIC HEALTH

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID70112

Entity Address

1450 POYDRAS ST.
Suite 2136
NEW ORLEANS, LA 70112

Grant Number

X07HA00018

Participating Start Date

7/1/1998

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

BRFHH SHREVEPORT LLC

Pharmacy Address

UNIVERSITY HEALTH SHREVEPORT
1606 KINGS HWY
SHREVEPORT, LA 71103-4128

Pharmacy Comments

Contract Details

Approval Date

1/7/2015

Contract Begin Date

1/8/2015

Carve-In Effective Date

Contract Comments

1/8/15-Immediate contract begin date authorized.

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

BRFHH Shreveport LLC dba University Health Shreveport
Jason Lafitte, Director of Pharmacy
(318) 626-0863

Signed By Date

1/7/2015

340B Drug Pricing Program Database