Covered Entity Details

DSH190176BG University Healthcare System.L.C. d/b/a East Jefferson General Hospital (Approved) - information as of 5/23/2025 12:13:34 AM

Main Details

Name

University Healthcare System.L.C. d/b/a East Jefferson General Hospital

Subdivision Name

EJGH PET FUSION CENTER - Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190176BG

Medicare Provider Number

190176

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/22/2025

Last Recertification Date

Contacts

Authorizing Official

LCMC Health
Bradley Scott Sinclair, CFO
(504) 962-6048

Primary Contact

University Healthcare System
Joanna Wood Bowles, Director of Pharmacy
(985) 867-4036

Addresses

Street Address

4204 HOUMA BLVD
METAIRIE, LA 70006-2903

Billing Address

University Healthcare System/ East Jefferson General Hospital
4200 Houma Blvd
Metairie, LA 70006

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH190176A	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - TULANE SURGERY CLINIC - NORTHSHORE - Surgery	101 JUDGE TANNER BLVD, STE 404	COVINGTON	LA	Active
DSH190176AA	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - TULANE CENTER FOR WOMEN'S HEALTH - OBGYN CL	4720 S I-10 SERVICE RD W	METAIRIE	LA	Active
DSH190176AB	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeside Operating Room - OP Surgery	4700 South I 10 Service Rd	Metairie	LA	Active
DSH190176AC	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - BMT Clinic - Bone Marrow Transplant Clinic	4224 Houma Boulevard STE 640	Metairie	LA	Active
DSH190176AD	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Surgery Clinic - Surgery Clinic	4224 Houma Blvd.	Metairie	LA	Active
DSH190176AE	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Tulane Pulmonary Clinic - Pulmonary	1415 Tulane Avenue	New Orleans	LA	Active
DSH190176AF	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	EJGH Multispecialty Clinic - MOB 300	4224 Houma Blvd.	Metairie	LA	Active
DSH190176AG	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Abdominal Transplant Clinic - Abdominal Transplant	4320 Houma Blvd.	Metairie	LA	Active
DSH190176AH	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Multispecialty Downtown	1415 Tulane Avenue	New Orleans	LA	Active
DSH190176AJ	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Tulane Urology Clinic - Urology Clinic	1415 Tulane Avenue	New Orleans	LA	Active
DSH190176AK	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Tulane Emergency Services - Emergency Services	1415 Tulane Avenue	New Orleans	LA	Active
DSH190176AL	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Neurosurgery Clinic - Neurosurgery	4224 Houma Blvd	Metairie	LA	Active
DSH190176AM	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Cardiology Clinic - Cardiology	4228 Houma Blvd.	Metairie	LA	Active
DSH190176AN	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Lakeside Dermatology Clinic - Dermatology	4720 South I-10 Service Road W Suite 201	Metarie	LA	Active
DSH190176AP	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - EJGH Pain Management - UHS - EJGH Pain Management	4320 Houma Blvd	Metairie	LA	Terminated
DSH190176AQ	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeview PACU - UHS - Lakeview PACU	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176AR	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeview Card Testing - UHS - Lakeview Card Testing	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176AS	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeview NEURODIAGNOSTICS - UHS - Lakeview NEURODIAGNOSTICS	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176AT	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeview MAMMO - UHS - Lakeview MAMMO	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176AU	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeview Cardiac Rehab - UHS - Lakeview Cardiac Rehab	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176AV	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeside Dialysis - UHS - Lakeside Dialysis	4700 I-10 Service Road W	Metairie	LA	Active
DSH190176AW	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Lakeside Pulmonary Rehab - UHS - Lakeside Pulmonary Rehab	4700 I-10 Service Road W	Metairie	LA	Active
DSH190176AX	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - EJGH Family Practice Center - UHS - EJGH Family Practice Center	4228 Houma Blvd	Metairie	LA	Active
DSH190176AY	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - EJGH Pulm Rehab - Suite 603	4320 Houma Blvd	Metairie	LA	Active
DSH190176AZ	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Rare Cancer Clinic - Oncology	4204 Houma Blvd	Metairie	LA	Active
DSH190176B	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS MULTISPECIALTY CLINIC Uptown Square	200 BROADWAY STREET	NEW ORLEANS	LA	Active
DSH190176BA	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Covington Neuroscience Clinic 402 - Neuroscience	101 Judge Tanner Blvd	Covington	LA	Active
DSH190176BB	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Tulane Lakeside Orthopedic Clinic 301 - Orthopedic	4720 S I-10 Service Rd W.	Metairie	LA	Active
DSH190176BC	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Tulane Surgical Specialty - Metairie 501 - Surgical	4720 S I-10 Service Rd W.	Metairie	LA	Active
DSH190176BD	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Hematology/Oncology Clinic - Oncology	4204 Houma Blvd	Metairie	LA	Active
DSH190176BE	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Lakeview Cath Lab - Surgical	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176BF	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS Tulane Women's Services - Ste 502 - LS - Women's Health	4720 S I-10 Service Rd W.	Metairie	LA	Active
DSH190176BG	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	EJGH PET FUSION CENTER - Oncology	4204 HOUMA BLVD	METAIRIE	LA	Approved
DSH190176C	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview MRI - MRI Unit	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176D	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Renal Dialysis - Hemo Dialysis	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176E	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview CT Scan - CAT Scan	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176F	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Radiology - Radiology	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176G	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Recovery Room - Recovery Room	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176H	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview OP Surgery - Day OP	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176J	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Operating Room - Surgery	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176K	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - TULANE WOMEN'S SERVICES - OBGYN CL	4720 S. I-10 SERVICE RD. W.	METAIRIE	LA	Active
DSH190176L	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - Tulane Metairie Multispecialty 101	4720 S I 10 SERVICE RD W	METAIRIE	LA	Active
DSH190176M	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - TULANE INSTITUTE OF SPORTS MEDICINE - Sports Medicine	202 MCALISTER EXTENSION	NEW ORLEANS	LA	Active
DSH190176N	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS DOWNTOWN MULTISPECIALTY CLIN - Downtown	275 LASALLE STREET	NEW ORLEANS	LA	Active
DSH190176P	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS - TULANE BREAST CENTER CLIN - Women's Health	4720 S. I-10 SERVICE RD. W.	METAIRIE	LA	Active
DSH190176Q	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	UHS CANCER CENTER - Oncology & Ambulatory Infusion	4204 Houma Blvd	Metarie	LA	Active
DSH190176R	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Respiratory Therapy - Respiratory Therapy	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176S	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Ultrasound - Ultrasound	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176T	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Delivery Room & Labor Room - L&D/Delivery	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176U	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Endoscopy - Endoscopy	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176V	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeside Delivery Room & Labor Room - Lakeside L&D	4700 South I 10 Service Rd	Metairie	LA	Active
DSH190176W	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeside OP Surgery - Lakeside OP Surgery	4700 South I 10 Service Rd	Metairie	LA	Active
DSH190176X	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeside Emergency Room - Emergency	4700 South I 10 Service Rd	Metairie	LA	Active
DSH190176Y	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Radioisotope - Nuclear	95 Judge Tanner Blvd	Covington	LA	Active
DSH190176Z	Child	DSH	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	Lakeview Emergency - Emergency	95 Judge Tanner Blvd	Covington	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Sinclair, Bradley Scott CFO LCMC Health 5049626048	4/22/2025 9:31 AM
Details	340B ID	Update	New Registration		DSH190176BG	4/22/2025 9:31 AM
Details	Entity Name	Update	New Registration	TULANE MEDICAL CENTER	University Healthcare System.L.C. d/b/a East Jefferson General Hospital	4/22/2025 9:31 AM
Details	Entity Subname	Update	New Registration	EJGH PET FUSION CENTER	EJGH PET FUSION CENTER - Oncology	4/22/2025 9:31 AM
Dates	Participating Approval Date	Update	New Registration		4/22/2025 9:31:18 AM	4/22/2025 9:31 AM
Details	State	Update	New Registration	Pending	Approved	4/22/2025 9:31 AM
Dates	Signed By Date	Update	New Registration		4/14/2025 5:08:10 PM	4/22/2025 9:31 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/22/2025 9:31 AM
Addresses	Main Address	Insert	New Registration		4204 HOUMA BLVD METAIRIE, LA 70006-2903	4/14/2025 4:44 PM
Addresses	Billing Address	Insert	New Registration		University Healthcare System/ East Jefferson General Hospital 4200 Houma Blvd Metairie, LA 70006	4/14/2025 4:44 PM
Contacts	Authorizing Official	Insert	New Registration		Sinclair, Bradley Scott CFO LCMC Health 5049626048	4/14/2025 4:44 PM
Contacts	Primary Contact	Insert	New Registration		Bowles, Joanna Wood Director of Pharmacy University Healthcare System 9858674036	4/14/2025 4:44 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 4:44 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 4:44 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 4:44 PM
Details	Grant Number	Insert	New Registration			4/14/2025 4:44 PM
Details	340B ID	Insert	New Registration			4/14/2025 4:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 4:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 4:44 PM
Details	Medicare Provider Number	Insert	New Registration		190176	4/14/2025 4:44 PM
Details	Entity Name	Insert	New Registration		TULANE MEDICAL CENTER	4/14/2025 4:44 PM
Details	NOFO Number	Insert	New Registration			4/14/2025 4:44 PM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 4:44 PM
Details	Entity Subname	Insert	New Registration		EJGH PET FUSION CENTER	4/14/2025 4:44 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 4:44 PM
Details	State	Insert	New Registration		Pending	4/14/2025 4:44 PM
Dates	Registration Date	Insert	New Registration		4/14/2025 4:44:01 PM	4/14/2025 4:44 PM
Dates	Signed By Date	Insert	New Registration			4/14/2025 4:44 PM
Dates	Start Date	Insert	New Registration			4/14/2025 4:44 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 4:44 PM
Terminations	Termination Date	Insert	New Registration			4/14/2025 4:44 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 4:44 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 4:44 PM