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OCHSNER SPECIALTY PHARMACY
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
OCHSNER SPECIALTY PHARMACY
Pharmacy Address
1405 JEFFERSON HWY
SUITE A
NEW ORLEANS, LA 70121
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Randolph, President
(318) 626-0982
Contract Pharmacy Representative
Ochsner Specialty Pharmacy
Christi Parson, Mgr-Specialty Pharmacy
(504) 842-3127
Signed By Date
4/13/2018
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