Covered Entity Details

DSH190151 RICHARDSON MEDICAL CENTER (Active) - information as of 4/27/2025 12:53:43 AM

Main Details

Name

RICHARDSON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH190151

Medicare Provider Number

190151

Additional Details

Current Program Status

Active

Registration Date

4/23/2008

Participating Start Date

7/1/2005

Participating Approval Date

4/23/2008

Last Recertification Date

9/8/2024

Contacts

Authorizing Official

Richardson Medical Center
James Barrett, CEO
(318) 728-8389

Primary Contact

Richardson Medical Center
RENEE CRAWFORD, DIRECTOR OF PHARMACY
(318) 728-8352

Addresses

Street Address

254 HWY 3048
RAYVILLE, LA 71269

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	1735370	1255370144

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	RAYVILLE FAMILY PHARMACY, LLC	1821 LOUISA ST	RAYVILLE	LA	71269-3523	01/15/2021	04/01/2021	08/26/2024	09/03/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300	SPRING	TX	77386	10/05/2018	01/01/2019		01/01/2019
Contract Detail	WAL-MART PHARMACY 10-0098	6091 MER ROUGE RD., HWY 165	BASTROP	LA	71220	04/11/2013	07/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-0307	1025 GLENWOOD DRIVE	WEST MONROE	LA	71291	04/11/2013	07/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-0976	3360 FRONT STREET	WINNSBORO	LA	71295	02/26/2013	04/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-0976	3360 FRONT STREET	WINNSBORO	LA	71295	10/05/2018	01/01/2019	01/01/2021	02/16/2021
Contract Detail	WAL-MART PHARMACY 10-1106	4283 CARTER STREET	VIDALIA	LA	71373	04/11/2013	07/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-1109	1806 S JULIA ST	RAYVILLE	LA	71269	02/26/2013	04/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-1109	1806 S JULIA ST	RAYVILLE	LA	71269	10/05/2018	01/01/2019		01/01/2019
Contract Detail	WAL-MART PHARMACY 10-1193	2701 LOUISVILLE AVENUE	MONROE	LA	71201	04/11/2013	07/01/2013	01/18/2016	01/18/2016
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100	ORLANDO	FL	32837	10/05/2018	01/01/2019		01/01/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH190151A	Child	DSH	RICHARDSON MEDICAL CENTER	Northeast Louisiana Rural Health Center	256 Hwy 3048	Rayville	LA	Active
DSH190151B	Child	DSH	RICHARDSON MEDICAL CENTER	Start Community Clinic	5975 FEDERAL HWY 80	RAYVILLE	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/3/2023 10:42:26 PM	9/8/2024 8:22:09 PM	9/8/2024 8:22 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 12:04:25 PM	9/3/2023 10:42:26 PM	9/3/2023 10:42 PM
Details	Last Recertification Date	Update	Recertification	9/13/2021 10:01:40 AM	9/13/2022 12:04:25 PM	9/13/2022 12:04 PM
Details	Last Recertification Date	Update	Recertification	8/24/2020 12:08:04 PM	9/13/2021 10:01:40 AM	9/13/2021 10:01 AM
Medicaid Billing	NPI: State	Update	Recertification		LA	8/24/2020 12:08 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 12:15:14 PM	8/24/2020 12:08:04 PM	8/24/2020 12:08 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 10:00:24 AM	9/5/2019 12:15:14 PM	9/5/2019 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255370144	9/6/2018 10:00 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 12:38:10 PM	9/6/2018 10:00:24 AM	9/6/2018 10:00 AM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/8/2017 12:38:10 PM	11/8/2017 12:38 PM
Contacts	Authorizing Official	Update		Barrett, James CEO 3187288389	Barrett, James CEO Richardson Medical Center 3187288389	10/23/2017 3:33 PM
Contacts	Primary Contact	Update		CRAWFORD, RENEE DIRECTOR OF PHARMACY 3187288352	CRAWFORD, RENEE DIRECTOR OF PHARMACY Richardson Medical Center 3187288352	10/23/2017 12:03 PM
Addresses	Main Address	Insert			254 HWY 3048 RAYVILLE, LA 71269	8/17/2016 3:39 PM
Contacts	Authorizing Official	Insert			Barrett, James CEO 3187288389	8/17/2016 3:39 PM
Contacts	Primary Contact	Insert			CRAWFORD, RENEE DIRECTOR OF PHARMACY 3187288352	8/17/2016 3:39 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/17/2016 3:39 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/24/2015 3:23 PM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 3:23 PM
Details	Last Recertification Date	Update		9/3/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:33 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/3/2013 12:00:00 AM	9/3/2013 12:47 PM
Dates	Participating Approval Date	Update		4/23/2008 2:51:05 PM	4/23/2008 12:00:00 AM	11/29/2012 9:45 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/22/2012 12:37 PM
Details	Last Recertification Date	Insert				4/23/2008 2:54 PM
Details	Grant Number	Insert				4/23/2008 2:54 PM
Details	340B ID	Insert			DSH190151	4/23/2008 2:54 PM
Details	Is Authorizing Official EHB Data	Insert				4/23/2008 2:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/23/2008 2:54 PM
Details	Medicare Provider Number	Insert			190151	4/23/2008 2:54 PM
Details	Entity Name	Insert			RICHARDSON MEDICAL CENTER	4/23/2008 2:54 PM
Details	Program Code	Insert			DSH	4/23/2008 2:54 PM
Details	Entity Subname	Insert				4/23/2008 2:54 PM
Dates	Participating Approval Date	Insert			4/23/2008 2:51:05 PM	4/23/2008 2:54 PM
Details	State	Insert			Active	4/23/2008 2:54 PM
Dates	Registration Date	Insert			4/23/2008 12:00:00 AM	4/23/2008 2:54 PM
Dates	Signed By Date	Insert				4/23/2008 2:54 PM
Dates	Start Date	Insert			7/1/2005 12:00:00 AM	4/23/2008 2:54 PM
Terminations	Termination Comments	Insert				4/23/2008 2:54 PM
Terminations	Termination Date	Insert				4/23/2008 2:54 PM
Terminations	Termination Effective Date	Insert				4/23/2008 2:54 PM
Terminations	Termination Reason	Insert				4/23/2008 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	4/23/2008 2:54 PM
Medicaid Billing	Medicaid: Number	Insert			1735370	4/23/2008 2:54 PM
Medicaid Billing	Medicaid: State	Insert			LA	4/23/2008 2:54 PM