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FRANCISCAN MISSIONARIES OF OUR LADY HEAL
DSH190125 ST FRANCIS MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ST FRANCIS MEDICAL CENTER, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190125
Entity Address
309 JACKSON STREET
MONROE, LA 71201
Medicare Provider Number
190125
Participating Start Date
4/1/2006
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN MISSIONARIES OF OUR LADY HEAL
Pharmacy Address
DBA RXONE TOWER DRIVE
2600 TOWER DR
STE 102
MONROE, LA 71201
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Belleau, Divisional Director, Ancillary Clinical Operations
(318) 966-4957
Contract Pharmacy Representative
FMOLHS
Adria Kerr, Corporate Director of Retail
(225) 765-9014
Signed By Date
1/12/2018
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