Covered Entity Details

DSH190017 OPELOUSAS GENERAL HOSPITAL (Active) - information as of 5/11/2025 11:50:42 PM

Main Details

Name

OPELOUSAS GENERAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190017

Medicare Provider Number

190017

Additional Details

Current Program Status

Active

Registration Date

1/11/2008

Participating Start Date

4/1/2003

Participating Approval Date

1/11/2008

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

190017
Jim Juneau, CFO
(337) 948-5133

Primary Contact

190017
Trey Turner, Pharmacy Manager
(337) 948-3884

Addresses

Street Address

539 EAST PRUDHOMME ST
OPELOUSAS, LA 70570

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
2/3/2010- UPDATED CONTACT INFO.; 5/26/04 MOD ADDR (WAS 520 PRUDHOMME LANE)	01/11/2008

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
LA	1720151	1447230388

Shipping Addresses

Shipping Address 1

Opelousas General Outpatient Pharmacy
539 E. Prudhomme Lane Floor 1
Opelousas, LA 70570

Shipping Address 2

Opelousas General Health System, South Campus
3983 I-49 South Service Road
Opelousas, LA 70570

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/14/2014	01/01/2015		10/14/2014
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	10/14/2014	01/01/2015		10/14/2014
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/14/2014	01/01/2015		10/14/2014
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/14/2014	01/01/2015		10/14/2014
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/14/2014	01/01/2015		10/14/2014
Contract Detail	ACCREDO HEALTH GROUP, INC.		PHARMACY 2 BOULDEN CIRCLE SUITE 1	NEW CASTLE	DE	19720	10/15/2014	01/01/2015	12/18/2019	12/18/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/06/2015	10/01/2015	12/18/2019	12/18/2019
Contract Detail	CVS PHARMACY, INC.	225 HARPERS LANDING BLVD		CONROE	TX	77385	10/08/2014	01/01/2015	07/30/2019	12/05/2019
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/11/2017	10/01/2017		10/01/2017
Contract Detail	FRED'S PHARMACY # 1324	109 CHEVY LANE	SUITE B	BUNKIE	LA	71322	04/13/2017	07/01/2017	10/29/2019	11/15/2019
Contract Detail	FRED'S PHARMACY #1526	2200 W LAUREL AVE		EUNICE	LA	70535-2910	04/13/2017	07/01/2017	10/29/2019	11/15/2019
Contract Detail	FRED'S PHARMACY #1684	821 SOUTH MAIN STREET		CHURCH POINT	LA	70525	04/01/2015	07/01/2015	08/02/2019	08/06/2019
Contract Detail	FRED'S PHARMACY #2004	812 VETERANS DRIVE		CARENCRO	LA	70520-3701	04/13/2017	07/01/2017	11/27/2018	02/12/2019
Contract Detail	INVERNESS APOTHECARY TRINITY	24333 GORDON TERRY PARKWAY	SUITE B	TRINITY	AL	35673	04/16/2018	07/01/2018	10/14/2022	11/11/2022
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05292	1013 EAST LANDRY STREET	OPELOUSAS	LA	70570	10/01/2013	01/01/2014		10/01/2013
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05511	3754 MOSS ST	LAFAYETTE	LA	70507	10/11/2018	01/01/2019	08/06/2019	08/06/2019
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05285	1315 MOSS ST EXT	LAFAYETTE	LA	70501	10/11/2018	01/01/2019	08/06/2019	08/06/2019
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05443	1920 KALISTE SALOOM	LAFAYETTE	LA	70508	10/11/2018	01/01/2019	08/06/2019	08/06/2019
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05306	120 TUNICA DR. EAST	MARKSVILLE	LA	71351	10/11/2018	01/01/2019	08/06/2019	08/06/2019
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05554	111 WESTGATE RD.	LAFAYETTE	LA	70506	10/11/2018	01/01/2019	08/06/2019	08/06/2019
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/14/2016	01/01/2017	10/29/2022	11/11/2022
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/11/2017	10/01/2017	10/01/2022	11/22/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2751	426 S. HENDERSON STREET	FORT WORTH	TX	76104	04/09/2018	07/01/2018		04/09/2018
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/14/2016	01/01/2017	10/29/2022	11/11/2022
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	10/14/2016	01/01/2017	10/29/2022	11/11/2022
Contract Detail	SPECIALTY CARE RX, LLC	150 COLLINS ST		MEMPHIS	TN	38112	04/16/2018	07/01/2018	10/14/2022	11/11/2022
Contract Detail	THRIFT CLINIC PHARMACY ON UNION LLC	825 N UNION		OPELOUSAS	LA	70570	07/08/2016	10/01/2016	10/01/2017	11/25/2019
Contract Detail	VITAL RX LLC	237 CAHABA VALLEY PARKWAY		PELHAM	AL	35124	04/16/2018	07/01/2018	10/14/2022	11/11/2022
Contract Detail	VITAL RX OF LOUISIANA	6200 LESLIE LN		LAKE CHARLES	LA	70615	04/16/2018	07/01/2018	10/14/2022	11/11/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WAL-MART PHARMACY 10-0312	891 E LA SALLE ST		VILLE PLATTE	LA	70586	09/05/2012	09/05/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-0402	1932 REES STREET		BREAUX BRIDGE	LA	70517	04/06/2017	07/01/2017	07/11/2019	07/17/2019
Contract Detail	WAL-MART PHARMACY 10-0534	1229 NW EVANGELINE THRUWAY		LAFAYETTE	LA	70501	04/06/2017	07/01/2017	05/01/2019	05/17/2019
Contract Detail	WAL-MART PHARMACY 10-0543	1629 EAST CRESSWELL LANE		OPELOUSAS	LA	70570	08/17/2012	08/17/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-0773	1538 US HIGHWAY 190		EUNICE	LA	70535	09/05/2012	09/05/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-2938	2428 WEST PINHOOK ROAD		LAFAYETTE (S)	LA	70508	04/06/2017	07/01/2017	07/11/2019	07/17/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WAL-MART PHARMACY 10-7301	3810 NE EVANGELINE THRUWAY		CARENCRO	LA	70520-5966	04/06/2017	07/01/2017		04/06/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07426	410 CRESWELL LANE	OPELOUSAS	LA	70570-5810	07/11/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05629	2822 AMBASSADOR CAFFERY PKWY	LAFAYETTE	LA	70506	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05747	3747 MOSS STREET	LAFAYETTE	LA	70507	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 10399	806 ODD FELLOWS RD	CROWLEY	LA	70526-2214	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07696	1401 REES STREET	BREAUX BRIDGE	LA	70517-4307	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11830	236 S MAIN STREET	MARKSVILLE	LA	71351	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12428	920 W. GLORIA SWITCH RD	LAFAYETTE	LA	70507	07/11/2017	10/01/2017	09/12/2019	09/12/2019
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #15198	1111 MEDICAL CENTER BLVD STE 116N	MARRERO	LA	70072	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16478	5555 ESSEN LN STE C	BATON ROUGE	LA	70809	10/09/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	10/09/2019	01/01/2020		01/01/2020
Contract Detail	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	04/11/2025	07/01/2025		04/11/2025
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/11/2017	10/01/2017		10/01/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/11/2017	10/01/2017		10/01/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/11/2017	10/01/2017		10/01/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/11/2017	10/01/2017	12/26/2019	12/30/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/11/2017	10/01/2017	12/26/2019	12/30/2019
Contract Detail	WALMART PHARMACY 10-5125	2310 S UNION STREET		OPELOUSAS	LA	70570	10/03/2016	01/01/2017		10/03/2016
Contract Detail	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	04/04/2017	07/01/2017	07/04/2018	05/17/2019
Contract Detail	WELLSMART PHARMACY SOUTH, LLC.	3939 I 49 S SERVICE RD		OPELOUSAS	LA	70570	10/11/2024	01/01/2025		01/01/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH190017A	Child	DSH	OPELOUSAS GENERAL HOSPITAL	OPELOUSAS GENERAL HOSPITAL SYSTEM, SOUTH CAMPUS	3983 I-49 SOUTH SERVICE ROAD	OPELOUSAS	LA	Terminated
DSH190017B	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Hospital Cancer Center	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017C	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Infusion Clinic	3983 I-49 South Service Road	OPELOUSAS	LA	Active
DSH190017D	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, Lab - Laboratory-South	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017E	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, ED - Emergency Department	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017F	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, Med Img - Medical Imaging-South Campus	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017G	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Hospital - Opelousas General Health System, Radiation Therapy	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017H	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Wellsmart Health of Opelousas - RHC - Wellsmart Health of Opelousas - RHC	1200 Hospital Drive	Opelousas	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 7:42:13 AM	8/28/2024 1:34:52 PM	8/28/2024 1:34 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 8:22:06 AM	8/23/2023 7:42:13 AM	8/23/2023 7:42 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:38:10 PM	8/29/2022 8:22:06 AM	8/29/2022 8:22 AM
Contacts	Primary Contact	Update	Group Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	Turner, Trey Pharmacy Manager 190017 3379483884	8/4/2022 4:43 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 11:20:17 AM	8/17/2021 2:38:10 PM	8/17/2021 2:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447230388	8/18/2020 11:20 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/18/2020 11:20 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1447230388 ( )		8/18/2020 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:34:31 AM	8/18/2020 11:20:17 AM	8/18/2020 11:20 AM
Addresses	Shipping Address	Insert	Change Request		Opelousas General Health System, South Campus 3983 I-49 South Service Road Opelousas, LA 70570	1/14/2020 10:13 AM
Contacts	Primary Contact	Update	Profile Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379405033	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	1/13/2020 4:20 PM
Contacts	Primary Contact	Update	Profile Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379405033	1/13/2020 4:19 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 11:51:20 AM	8/28/2019 9:34:31 AM	8/28/2019 9:34 AM
Addresses	Shipping Address	Insert	Change Request		Opelousas General Outpatient Pharmacy 539 E. Prudhomme Lane Floor 1 Opelousas, LA 70570	9/25/2018 2:23 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 7:28:17 PM	8/22/2018 11:51:20 AM	8/22/2018 11:51 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/29/2017 7:28:17 PM	11/29/2017 7:28 PM
Contacts	Primary Contact	Update		Fusilier, Troy DIRECTOR OF PHARMACY 3379485133	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	11/13/2017 11:38 AM
Contacts	Authorizing Official	Update		Juneau, Jim CFO 3379485133	Juneau, Jim CFO 190017 3379485133	10/25/2017 10:22 AM
Contacts	Authorizing Official	Update		KIRK, BRIAN CFO 3379485113	Juneau, Jim CFO 3379485133	7/11/2017 3:24 PM
Contacts	Primary Contact	Insert			Fusilier, Troy DIRECTOR OF PHARMACY 3379485133	9/8/2016 9:51 AM
Addresses	Main Address	Insert			539 EAST PRUDHOMME ST OPELOUSAS, LA 70570	9/8/2016 9:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/8/2016 9:50 AM
Medicaid Billing	Medicaid: Number	Insert			1720151	9/8/2016 9:50 AM
Medicaid Billing	Medicaid: State	Insert			LA	9/8/2016 9:50 AM
Medicaid Billing	NPI: Number	Insert			1447230388	9/8/2016 9:50 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 11:49 AM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 11:17 AM
Details	Last Recertification Date	Update		8/29/2013 3:42:12 PM	8/7/2014 12:00:00 AM	8/7/2014 8:10 AM
Contacts	Authorizing Official	Insert			KIRK, BRIAN CFO 3379485113	7/3/2014 4:20 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/29/2013 3:42:12 PM	8/29/2013 3:42 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/22/2012 12:34 PM
Details	Last Recertification Date	Insert				1/11/2008 3:11 PM
Details	Grant Number	Insert				1/11/2008 3:11 PM
Details	340B ID	Insert			DSH190017	1/11/2008 3:11 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2008 3:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2008 3:11 PM
Details	Medicare Provider Number	Insert			190017	1/11/2008 3:11 PM
Details	Entity Name	Insert			OPELOUSAS GENERAL HOSPITAL	1/11/2008 3:11 PM
Details	Program Code	Insert			DSH	1/11/2008 3:11 PM
Details	Entity Subname	Insert				1/11/2008 3:11 PM
Dates	Participating Approval Date	Insert			1/11/2008 12:00:00 AM	1/11/2008 3:11 PM
Details	State	Insert			Active	1/11/2008 3:11 PM
Dates	Registration Date	Insert			1/11/2008 12:00:00 AM	1/11/2008 3:11 PM
Dates	Signed By Date	Insert				1/11/2008 3:11 PM
Dates	Start Date	Insert			4/1/2003 12:00:00 AM	1/11/2008 3:11 PM
Terminations	Termination Comments	Insert				1/11/2008 3:11 PM
Terminations	Termination Date	Insert				1/11/2008 3:11 PM
Terminations	Termination Effective Date	Insert				1/11/2008 3:11 PM
Terminations	Termination Reason	Insert				1/11/2008 3:11 PM
Details	Comments Public	Insert			2/3/2010- UPDATED CONTACT INFO.; 5/26/04 MOD ADDR (WAS 520 PRUDHOMME LANE)	1/11/2008 3:11 PM