Covered Entity Details

DSH190020 LANE REGIONAL MEDICAL CENTER (Active) - information as of 5/13/2025 1:35:06 AM

Main Details

Name

LANE REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190020

Medicare Provider Number

190020

Additional Details

Current Program Status

Active

Registration Date

3/10/2008

Participating Start Date

4/1/2008

Participating Approval Date

3/11/2008

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Lane Regional Medical Center
Frank Corcoran, CEO
(225) 658-4303

Primary Contact

Lane Regional Medical Center
Jassoni Shae Martin, Director of Pharmacy
(225) 658-4364

Addresses

Street Address

6300 MAIN STREET
ZACHARY, LA 70791

Billing Address
Same as Street Address

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?
Yes

State	Medicaid Number	NPI Number
LA	1720101	1376591941

Shipping Addresses

Shipping Address 1

Lane Regional Medical Center
6300 Main St
Zachary, LA 70791

Shipping Address 2

Lane Pharmacy
6300 Main St, Suite100
LA
Zachary, LA 70791

Shipping Address 3

Lane Rx
6400 Main Street
Zachary, LA 70791

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	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/23/2015	10/01/2015	05/31/2016	05/03/2017
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	01/15/2016	04/01/2016	01/02/2023	04/14/2023
Contract Detail	CENTRAL DRUG STORE INC	DBA: CENTRAL PHARMACY	9952 SULLIVAN RD DBA CENTRAL PHARMACY	BATON ROUGE	LA	70818-4300	11/15/2010	11/24/2010	08/01/2015	05/03/2017
Contract Detail	CVS PHARMACY, INC	800 CVS DR		ENNIS	TX	75119	10/06/2014	01/01/2015	08/15/2015	05/03/2017
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	04/15/2021	07/01/2021		07/01/2021
Contract Detail	DRY'S PHARMACY	4344 CHURCH ST.		ZACHARY	LA	70791	04/21/2011	04/29/2011	08/01/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01116	7777 BLUEBONNET BLVD,, SUITE 100	BATON ROUGE	LA	70810	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01661	17122 AIRLINE HWY.	PRAIRIEVILLE	LA	70769	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05297	201 N. CANAL BLVD.	THIBODAUX	LA	70301	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05318	9006 GREENWELL SPRINGS RD	BATON ROUGE	LA	70814	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05319	5889 AIRLINE HWY	BATON ROUGE	LA	70805	10/01/2013	01/01/2014	05/31/2016	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05321	1214 MAIN ST	BAKER	LA	70714	10/01/2013	01/01/2014	05/31/2016	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05322	9608 JEFFERSON HWY	BATON ROUGE	LA	70809	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05324	3384 GOVERNMENT ST	BATON ROUGE	LA	70806	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05338	7015 PARK AVE	HOUMA	LA	70364	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05354	1624 N. BURNSIDE	GONZALES	LA	70737	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05374	14360 WAX ROAD	BATON ROUGE	LA	70818	10/01/2013	01/01/2014	05/31/2016	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05615	2520 PLANK RD	BATON ROUGE	LA	70805	10/01/2013	01/01/2014	05/31/2016	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05617	29881 WALKER RD. SOUTH/ PO BOX 1448	WALKER	LA	70785	10/01/2013	01/01/2014	05/31/2016	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08309	5360 HIGHLAND RD.,	BATON ROUGE	LA	70808	10/01/2013	01/01/2014	08/15/2015	05/03/2017
Contract Detail	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #1924	20501 OLD SCENIC HWY	ZACHARY	LA	70791-7365	07/01/2016	10/01/2016	12/21/2016	05/03/2017
Contract Detail	MEDICAL PHARMACY	6400 MAIN ST.	PO BOX 475	ZACHARY	LA	70791	11/23/2010	11/23/2010	01/02/2023	04/10/2023
Contract Detail	MEDICAL PHARMACY WEST	2250 CHURCH STREET	PO BOX 475	ZACHARY	LA	70791	11/30/2010	11/30/2010	01/02/2023	04/10/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	01/15/2016	04/01/2016		05/03/2017
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/26/2017	04/01/2017		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-0428	5801 MAIN STREET		ZACHARY	LA	70791	02/27/2012	02/27/2012		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-0839	9350 CORTANA PL		BATON ROUGE	LA	70815	07/23/2015	10/01/2015	08/15/2015	05/03/2017
Contract Detail	WAL-MART PHARMACY 10-1025	1608 VETERANS BLVD		MCCOMB	MS	39648	04/01/2014	07/01/2014	08/01/2015	05/03/2017
Contract Detail	WAL-MART PHARMACY 10-1102	14507 PLANK ROAD		BAKER	LA	70714	02/27/2012	02/27/2012	05/31/2016	05/03/2017
Contract Detail	WAL-MART PHARMACY 10-3288	10200 SULLIVAN ROAD		BATON ROUGE (CENTRAL)	LA	70818	02/27/2012	02/27/2012	05/31/2016	05/03/2017
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/12/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/26/2017	04/01/2017		05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02982	5450 PLANK ROAD	BATON ROUGE	LA	70805	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02995	3550 GOVERNMENT ST	BATON ROUGE	LA	70806	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07795	6515 SULLIVAN RD	GREENWELL SPRINGS	LA	70739-3110	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07836	3671 JOOR ROAD	BATON ROUGE	LA	70814-3104	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09860	5955 AIRLINE HWY	BATON ROUGE	LA	70805-3202	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 10400	34865 LA HWY 16	DENHAM SPRINGS	LA	70706-0669	07/19/2013	10/01/2013	08/15/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11196	12506 HIGHWAY 73	GEISMAR	LA	70734-3209	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 11498	5061 MAIN STREET	ZACHARY	LA	70791	07/19/2013	10/01/2013	12/21/2016	05/03/2017
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA:WALGREENS #13779	39527 HWY 42	PRAIRIEVILLE	LA	70769	07/19/2013	10/01/2013	08/01/2015	05/03/2017
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/19/2013	10/01/2013	08/10/2015	05/03/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/05/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WINN DIXIE MONTGOMERY, LLC.		WINN DIXIE PHARMACY # 1581 5005 CHURCH ST	ZACHARY	LA	70791	01/08/2014	04/01/2014	12/21/2016	05/03/2017
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1576	10974 JOOR RD	BATON ROUGE	LA	70818	07/15/2021	10/01/2021	03/31/2024	10/18/2024
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1444	12125 HWY 90	LULING	LA	70070	07/15/2021	10/01/2021	03/31/2024	10/18/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH190020A	Child	DSH	LANE REGIONAL MEDICAL CENTER	LANE REGIONAL MEDICAL CENTER BEHAVI	4801 McHugh	ZACHARY	LA	Terminated
DSH190020B	Child	DSH	LANE REGIONAL MEDICAL CENTER	LANE WOUND CARE	4917 WEST PARK DRIVE	ZACHARY	LA	Active
DSH190020C	Child	DSH	LANE REGIONAL MEDICAL CENTER	Lane Cancer Center	6180 Main Street, Suite A	Zachary	LA	Active
DSH190020D	Child	DSH	LANE REGIONAL MEDICAL CENTER	LANE RMC ENDOSCOPY	6550 MAIN ST	ZACHARY	LA	Active
DSH190020E	Child	DSH	LANE REGIONAL MEDICAL CENTER	OUTPATIENT DIAGNOSTIC CENTER	6550 MAIN STREET	ZACHARY	LA	Terminated
DSH190020F	Child	DSH	LANE REGIONAL MEDICAL CENTER	Lane Surgery Group	4801 McHugh Rd	Zachary	LA	Active
DSH190020G	Child	DSH	LANE REGIONAL MEDICAL CENTER	Lane Family Practice	2335 CHURCH ST STE E	ZACHARY	LA	Active
DSH190020H	Child	DSH	LANE REGIONAL MEDICAL CENTER	HOSPITAL SERVICE DISTRICT 1 OF EAST / Fastlane Clinic	19900 OLD SCENIC HWY, STE H&I	ZACHARY	LA	Terminated
DSH190020J	Child	DSH	LANE REGIONAL MEDICAL CENTER	LANE OB/GYN-ZACHARY - Obstetrics and Gynecology	6550 MAIN ST	ZACHARY	LA	Active
DSH190020K	Child	DSH	LANE REGIONAL MEDICAL CENTER	LANE GASTROENTEROLOGY - Gastroenterology	6550 MAIN ST	ZACHARY	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Meese, Larry CEO Lane Regional Medical Center 2256584303	Corcoran, Frank CEO Lane Regional Medical Center 2256584303	1/23/2025 7:38 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:30:22 PM	8/28/2024 9:25:38 AM	8/28/2024 9:25 AM
Details	Last Recertification Date	Update	Recertification	9/18/2022 8:57:49 PM	9/5/2023 10:30:22 PM	9/5/2023 10:30 PM
Addresses	Shipping Address	Insert	Change Request		Lane Rx 6400 Main Street Zachary, LA 70791	8/14/2023 7:53 AM
Contacts	Primary Contact	Update	PC Change Request	Beck, David COO Lane Regional Medical Center 2256584594	Martin, Jassoni Shae Director of Pharmacy Lane Regional Medical Center 2256584364	3/15/2023 12:48 PM
Contacts	Authorizing Official	Update	AO Change Request	Peacock, Alexsander Tewelde Director of Pharmacy Lane Regional Medical Center 3183815222	Meese, Larry CEO Lane Regional Medical Center 2256584303	3/15/2023 7:25 AM
Details	Last Recertification Date	Update	Recertification	9/11/2021 6:25:33 PM	9/18/2022 8:57:49 PM	9/18/2022 8:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1376591941	9/11/2021 6:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/11/2021 6:25 PM
Details	Last Recertification Date	Update	Recertification	9/15/2020 8:27:30 AM	9/11/2021 6:25:33 PM	9/11/2021 6:25 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 9:39:25 PM	9/15/2020 8:27:30 AM	9/15/2020 8:27 AM
Contacts	Authorizing Official	Update	AO Change Request	Hacker, Phil Chief Financial Officer Lane Regional Medcial Center 2256584505	Peacock, Alexsander Tewelde Director of Pharmacy Lane Regional Medical Center 3183815222	9/10/2020 8:50 AM
Contacts	Primary Contact	Update	Change Request	Stelly, Jennie DIRECTOR OF PHARMACY Lane Regional Medical Center 2256584364	Beck, David COO Lane Regional Medical Center 2256584594	10/30/2019 3:24 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 12:31:43 PM	8/21/2019 9:39:25 PM	8/21/2019 9:39 PM
Addresses	Shipping Address	Delete	Change Request	Lane Pharmacy 6300 Main St Suite 100 LA Zachary, LA 70791		2/27/2019 11:32 AM
Addresses	Shipping Address	Insert	Change Request		Lane Pharmacy 6300 Main St, Suite100 LA Zachary, LA 70791	2/27/2019 11:32 AM
Addresses	Shipping Address	Insert	Change Request		Lane Regional Medical Center 6300 Main St Zachary, LA 70791	2/27/2019 9:40 AM
Addresses	Shipping Address	Insert	Change Request		Lane Pharmacy 6300 Main St Suite 100 LA Zachary, LA 70791	2/26/2019 12:40 PM
Contacts	Authorizing Official	Update	Change Request	Braccino, Nick Interim CFO Lane Regional Medical Center 2256584505	Hacker, Phil Chief Financial Officer Lane Regional Medcial Center 2256584505	8/27/2018 6:33 AM
Details	Last Recertification Date	Update	Recertification	11/3/2017 10:08:43 AM	8/15/2018 12:31:43 PM	8/15/2018 12:31 PM
Contacts	Authorizing Official	Update	AO Change Request	Anderson, Mark Chief Financial Officer Hospital Service District No. 1 of East Baton Rouge 2256584302	Braccino, Nick Interim CFO Lane Regional Medical Center 2256584505	8/14/2018 12:02 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 5:12:40 PM	11/3/2017 10:08:43 AM	11/3/2017 10:08 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	10/25/2017 5:12:40 PM	10/25/2017 5:12 PM
Contacts	Primary Contact	Update		Stelly, Jennie DIRECTOR OF PHARMACY 2256584364	Stelly, Jennie DIRECTOR OF PHARMACY Lane Regional Medical Center 2256584364	10/20/2017 4:12 PM
Contacts	Authorizing Official	Update		ZIMMERMAN, MICHAEL H. CFO 2256584301	Anderson, Mark Chief Financial Officer Hospital Service District No. 1 of East Baton Rouge 2256584302	5/3/2017 1:19 PM
Addresses	Main Address	Insert			6300 MAIN STREET ZACHARY, LA 70791	5/3/2017 1:19 PM
Contacts	Primary Contact	Update		JOHNSON, JOHNNY W. DIRECTOR OF PHARMACY 2256584364	Stelly, Jennie DIRECTOR OF PHARMACY 2256584364	5/3/2017 1:19 PM
Details	Last Recertification Date	Update		8/26/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 3:32 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/26/2015 12:00:00 AM	8/26/2015 2:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/2/2015 5:55 PM
Medicaid Billing	Medicaid: Number	Insert			1720101	6/2/2015 5:55 PM
Medicaid Billing	Medicaid: State	Insert			LA	6/2/2015 5:55 PM
Contacts	Primary Contact	Insert			JOHNSON, JOHNNY W. DIRECTOR OF PHARMACY 2256584364	9/5/2014 11:51 AM
Details	Last Recertification Date	Update		8/19/2013 12:00:00 AM	9/5/2014 12:00:00 AM	9/5/2014 11:51 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 12:00:00 AM	8/19/2013 9:18 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 7:45 AM
Contacts	Authorizing Official	Insert			ZIMMERMAN, MICHAEL H. CFO 2256584301	3/11/2008 6:52 AM
Details	Last Recertification Date	Insert				3/11/2008 6:52 AM
Details	Grant Number	Insert				3/11/2008 6:52 AM
Details	340B ID	Insert			DSH190020	3/11/2008 6:52 AM
Details	Is Authorizing Official EHB Data	Insert				3/11/2008 6:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/11/2008 6:52 AM
Details	Medicare Provider Number	Insert			190020	3/11/2008 6:52 AM
Details	Entity Name	Insert			LANE REGIONAL MEDICAL CENTER	3/11/2008 6:52 AM
Details	Program Code	Insert			DSH	3/11/2008 6:52 AM
Details	Entity Subname	Insert				3/11/2008 6:52 AM
Dates	Participating Approval Date	Insert			3/11/2008 12:00:00 AM	3/11/2008 6:52 AM
Details	State	Insert			Active	3/11/2008 6:52 AM
Dates	Registration Date	Insert			3/10/2008 12:00:00 AM	3/11/2008 6:52 AM
Dates	Signed By Date	Insert			2/27/2008 12:00:00 AM	3/11/2008 6:52 AM
Dates	Start Date	Insert			4/1/2008 12:00:00 AM	3/11/2008 6:52 AM
Terminations	Termination Comments	Insert				3/11/2008 6:52 AM
Terminations	Termination Date	Insert				3/11/2008 6:52 AM
Terminations	Termination Effective Date	Insert				3/11/2008 6:52 AM
Terminations	Termination Reason	Insert				3/11/2008 6:52 AM