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Legal Name & Address of Institution

Ochsner Clinic Foundation
1514 Jefferson Highway New Orleans, Louisiana 70121

Official Signature on Application

William W. Pinsky, MD, Executive Vice President of Medical Affairs and Chief Academic Officer 
Telephone: (504) 842-6120

Administrative Official to be Notified if Award is Made

Mr. Bobby C. Brannon, Executive V.P.
Treasurer
Telephone: (504) 842-3135
Fax: (504) 842-3899

Other Numbers

Assurance of Compliance Number for IACUC: A-3126-01

Congressional District: 01

Entity Identification Number: 1720446137A1

Type of Organization: 60

DHHS Agreement Date: 1/02/01