340B Drug Pricing Program Database


DSH190102 OUR LADY OF LOURDES RMC (Active) - information as of 5/1/2025 11:50:57 PM

Main Details
OUR LADY OF LOURDES RMC
Disproportionate Share Hospital
No
DSH190102
190102


Additional Details
Active
10/1/2019
1/1/2020
11/15/2019
8/13/2024

Contacts

Our Lady of Lourdes Health
Jeremy Rogers, VP, Chief Financial Officer
(337) 470-2147

Our Lady of Lourdes Regional Medical Center
Stacy Boatright, Director of Pharmacy
(337) 470-2111

Addresses

4801 AMBASSADOR CAFFERY PRKWY
LAFAYETTE, LA 70508

FMOLHS ACCOUNTS PAYABLE
PO BOX 83880
BATON ROUGE, LA 70884-3880


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 4/1/2012, terminated 7/1/2013. Reinstated 1/1/2020.10/24/2019
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
LA17204451598766495
Shipping Addresses

Our Lady of Lourdes Regional Medical Ctr. Pharmacy
4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917

Our Lady of Lourdes Heart Hospital
1105 Kaliste Saloom Rd
Lafayette, LA 70508-5705

Our Lady of Lourdes Women's and Children
4600 Ambassador Caffery Pkwy
Lafayette, LA 70508

Our Lady of Lourdes Infusion Pharmacy
4809 Ambassador Caffery Pkwy
Ste 120
Lafayette, LA 70508-8800
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/07/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/07/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/07/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/07/202210/01/2022 01/31/202402/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/07/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/07/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/07/202210/01/2022  10/01/2022
Contract DetailFRANCISCAN MISSIONARIES OF OUR LADY HEALDBA RXONE LOURDES 4809 AMBASSADOR CAFFERY PKWY
STE 120A 		LAFAYETTELA7050810/06/202001/01/2021  01/01/2021
Contract DetailFRANCISCAN MISSIONARIES OF OUR LADY HEALDBA RXONE ASCENSION 1014 WEST ST. CLAIRE BLVD STE 1010
GONZALESLA7073701/05/202104/01/2021  09/07/2022
Contract DetailFRANCISCAN MISSIONARIES OF OUR LADY HEALDBA RXONE MED PLAZA 7777 HENNESSY BLVD.
STE. 114 		BATON ROUGELA7080801/05/202104/01/2021  09/07/2022
Contract DetailFRANCISCAN MISSIONARIES OF OUR LADY HEALDBA RXONE TOWER DRIVE 2600 TOWER DR
STE 102 		MONROELA7120101/05/202104/01/2021  09/07/2022
Contract DetailFRANCISCAN MISSIONARIES OF OUR LADY HEALRXONE ST FRANCIS 309 JACKSON ST
FLOOR 1 		MONROELA71201-740701/05/202104/01/2021  09/07/2022
Contract DetailO'DONOVAN PHARMACY5131 ODONOVAN DR STE 402
BATON ROUGELA70808-479204/01/202207/01/2022  09/07/2022
Contract DetailRXONE LAKE5000 HENNESSY BLVD CHAPEL HALLWAY RM 101
BATON ROUGELA7080801/05/202104/01/2021  09/07/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07393 2201 VETERANS MEMORIAL DR
ABBEVILLELA70510-400407/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 04626 2517 KALISTE SALOOM ROAD
LAFAYETTELA7050807/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05629 2822 AMBASSADOR CAFFERY PKWY
LAFAYETTELA7050607/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 04566 2700 JOHNSTON ST.
LAFAYETTELA7050307/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13761 2820 E. MILTON AVE.
YOUNGSVILLELA70592-534907/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13134 6130 JOHNSTON ST.
LAFAYETTELA7050307/18/202210/01/2022 07/09/202407/09/2024
Contract DetailWalgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626204/14/202307/01/2023 07/09/202407/09/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH190102AChildDSHOUR LADY OF LOURDES RMCOUR LADY OF LOURDES REGIONAL MEDICA - Woundcare Center4809 AMBASSADOR CAFFERY PKWY, STE 390LAFAYETTELAActive
DSH190102AAChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S REHAB SERVICE - REHAB SERVICES4630 AMBASSADOR CAFFERY PKWY.LAFAYETTELAActive
DSH190102ABChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL CATH LAB - HHL CATH LAB1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ACChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL COUMADIN SERVICES- HHL COUMADIN LAFAYETTE1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ADChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL COUMADIN CLINC - Heart Hospital Coumadin Clinic Abbeville2621 NORTH DR. (Lahasky Medical Building)ABBEVILLELAActive
DSH190102AEChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL SMOKING CESSATION PROGRAM - SMOKING CESSATION1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AFChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL RESPIRATORY THERAPY - HHL RESPIRATORY THERAPY1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AGChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL PHYSICAL THERAPY - HHL PT1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AHChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL SPEECH THERAPY - HHL SPEECH1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AJChildDSHOUR LADY OF LOURDES RMCOUR LADY OF LOURDES ED - SCOTT - SCOTT ER662 I-10 North Frontage RoadSCOTTLAActive
DSH190102AKChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL LABORATORY - HHL LAB1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ALChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL IMAGING1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AMChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL CAT SCAN - HHL CT1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ANChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL DAY PATIENT - HHL DAY PATIENT1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102APChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL CARDIAC REHAB - HHL CARDIAC REHAB1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102AQChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL OPERATING ROOM - HEART OR1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ARChildDSHOUR LADY OF LOURDES RMCHEART HOSPITAL EMERGENCY ROOM - HHL ER1105 KALISTE SALOOM RDLAFAYETTELAActive
DSH190102ASChildDSHOUR LADY OF LOURDES RMCLourdes Breast Center - Imaging Services2311 KALISTE SALOOM ROADLafayetteLAActive
DSH190102ATChildDSHOUR LADY OF LOURDES RMCLOURDES SLEEP DISORDER CENTER - Sleep Center100 ASMA BLVDLafayetteLAActive
DSH190102AUChildDSHOUR LADY OF LOURDES RMCLOURDES SLEEP DISORDER CENTER AT CROWLEY - Sleep Center-Crowley1325 WRIGHT AVE STE 1CROWLEYLATerminated
DSH190102AVChildDSHOUR LADY OF LOURDES RMCLOURDES ST. MARY IMAGING - Imaging Services411 St. Landry StreetLAFAYETTELAActive
DSH190102AWChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN'S GENETICS - LAFAYETTE - GENETICS SERVICES4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 202LAFAYETTELAActive
DSH190102AXChildDSHOUR LADY OF LOURDES RMCWomen's and Children's Emergency Department - Emergency Services4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102AYChildDSHOUR LADY OF LOURDES RMCWCH ANESTHESIA - ANESTHESIA SERVICES4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102AZChildDSHOUR LADY OF LOURDES RMCOLOL Children's Endocrinology - Endocrinology services4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 203LAFAYETTELAActive
DSH190102BChildDSHOUR LADY OF LOURDES RMCJD MONCUS CANCER CENTER - Outpatient Infusion4809 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102BAChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN'S GENERAL SURGERY - LAFAYETTE - GENERAL SURGERY4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 200LAFAYETTELAActive
DSH190102BBChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN'S NEUROLOGY - LAFAYETTE - NEUROLOGY SERVICES4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 201LAFAYETTELAActive
DSH190102BCChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN'S NEUROSURGERY - LAFAYETTE - NEUROSURGERY4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 204LAFAYETTELAActive
DSH190102BDChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN ORTHOPEDIC - LAFAYETTE - ORTHOPEDIC SERVICES4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 100LAFAYETTELAActive
DSH190102BEChildDSHOUR LADY OF LOURDES RMCOLOL CHILDREN'S PULMONOLOGY - LAFAYETTE - PULMONOLOGY SERVICES4704 AMBASSADOR CAFFERY PKWY BUILDING E STE 300ALAFAYETTELAActive
DSH190102BFChildDSHOUR LADY OF LOURDES RMCHeart Hospital Coumadin Services Scott - Coumadin Clinic-Scott662 I-10 N FrontageSCOTTLAActive
DSH190102BGChildDSHOUR LADY OF LOURDES RMCLourdes WCH EEG - WCH EEG4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102CChildDSHOUR LADY OF LOURDES RMCJD MONCUS CANCER CENTER - Cancer Clinic4809 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102DChildDSHOUR LADY OF LOURDES RMCLOURDES IMAGING CTR - ACC - Lourdes Imaging Center-ACC4809 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102EChildDSHOUR LADY OF LOURDES RMCWCH AUDIOLOGY - WCH AUDIOLOGY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102FChildDSHOUR LADY OF LOURDES RMCWCH KIDS RADIOLOGY - WCH KIDS RADIOLOGY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELATerminated
DSH190102GChildDSHOUR LADY OF LOURDES RMCWCH PHYSICAL THERAPY - WCH PHYSICAL THERAPY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102HChildDSHOUR LADY OF LOURDES RMCWCH LABOR & DELIVERY - WCH LABOR & DELIVERY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102JChildDSHOUR LADY OF LOURDES RMCWCH OCCUPATIONAL THERAPY - WCH OCCUPATIONAL THERAPY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELATerminated
DSH190102KChildDSHOUR LADY OF LOURDES RMCWCH US IMAGING4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102LChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S SPECIAL PROCEDURE - WCH SPECIAL PROCEDURE4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102MChildDSHOUR LADY OF LOURDES RMCWCH BLOOD BANK - WCH BLOOD BANK4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102NChildDSHOUR LADY OF LOURDES RMCWCH CANCER AND INFUSION CENTER - Children's Infusion4704 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102PChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S NUCLEAR MEDICINE - WCH NUCLEAR MEDICINE4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102QChildDSHOUR LADY OF LOURDES RMCWCH XR IMAGING4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102RChildDSHOUR LADY OF LOURDES RMCWCH CT IMAGING - WCH CT IMAGING4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102SChildDSHOUR LADY OF LOURDES RMCWCH DAY OPERATING SURGERY - WCH DAY OPERATING SURGERY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102TChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S SURGERY - WCH SURGERY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102UChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S RECOVERY - WCH RECOVERY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102VChildDSHOUR LADY OF LOURDES RMCWCH PATHOLOGY - WCH PATHOLOGY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102WChildDSHOUR LADY OF LOURDES RMCWCH RESPIRATORY - WCH RESPIRATORY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102XChildDSHOUR LADY OF LOURDES RMCWCH MRI - WCH MRI4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102YChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDREN'S LABORATORY - WOMEN'S AND CHILDREN'S LABORATORY4600 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
DSH190102ZChildDSHOUR LADY OF LOURDES RMCWOMEN'S AND CHILDRENS SLEEP LAB - SLEEP LAB4630 AMBASSADOR CAFFERY PKWYLAFAYETTELAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressDeleteChange RequestWCH Cancer and Infusion Center 4704 Ambassador Caffery Pkwy Ste 300A Lafayette, LA 70508-6908 8/26/2024 11:12 AM
DetailsLast Recertification DateUpdateRecertification9/11/2023 9:33:58 AM8/13/2024 11:34:53 AM8/13/2024 11:34 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestRogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 3189667212Rogers, Jeremy VP, Chief Financial Officer Our Lady of Lourdes Health 33747021474/30/2024 7:27 AM
ContactsAuthorizing OfficialUpdateChange RequestStanton, Lowell Edward Chief Financial Officer Our Lady of the Lourdes Medical Center 3374702147Rogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 31896672124/29/2024 7:51 AM
DetailsLast Recertification DateUpdateRecertification9/19/2022 6:18:13 PM9/11/2023 9:33:58 AM9/11/2023 9:33 AM
AddressesBilling AddressUpdateChange RequestFMOLHS ACCOUNTS PAYABLE PO BOX 83880 BATON ROUGE, LA 70884FMOLHS ACCOUNTS PAYABLE PO BOX 83880 BATON ROUGE, LA 70884-38804/27/2023 9:18 AM
AddressesBilling AddressUpdateChange RequestFMOLHS ACCOUNTS PAYABLE P O BOX 83880 BATON ROUGE, LA 70884FMOLHS ACCOUNTS PAYABLE PO BOX 83880 BATON ROUGE, LA 7088410/7/2022 10:33 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestStanton, Lowell Edward Chief Financial Officer Our Lady of the Lake Regional Medical Center 2257658550Stanton, Lowell Edward Chief Financial Officer Our Lady of the Lourdes Medical Center 337470214710/3/2022 4:09 PM
DetailsLast Recertification DateUpdateRecertification8/17/2021 10:51:27 AM9/19/2022 6:18:13 PM9/19/2022 6:18 PM
ContactsAuthorizing OfficialUpdateAO Change RequestKiser, Crystal R Manager Our Lady of Lourdes Regional Medical Center 3374702131Stanton, Lowell Edward Chief Financial Officer Our Lady of the Lake Regional Medical Center 22576585508/30/2022 7:38 AM
ContactsPrimary ContactUpdateChange RequestBroussard, Edward L. Director of Pharmacy Our Lady of Lourdes Regional Medical Center 3374702111Boatright, Stacy Director of Pharmacy Our Lady of Lourdes Regional Medical Center 33747021117/12/2022 10:13 AM
AddressesBilling AddressInsertChange Request FMOLHS ACCOUNTS PAYABLE P O BOX 83880 BATON ROUGE, LA 7088412/13/2021 10:06 AM
DetailsLast Recertification DateUpdateRecertification8/18/2020 1:50:51 PM8/17/2021 10:51:27 AM8/17/2021 10:51 AM
AddressesShipping AddressInsertChange Request Our Lady of Lourdes Heart Hospital 1105 Kaliste Saloom Rd Lafayette, LA 70508-57057/27/2021 7:19 AM
AddressesShipping AddressInsertChange Request Our Lady of Lourdes Women's and Children 4600 Ambassador Caffery Pkwy Lafayette, LA 705087/27/2021 7:19 AM
AddressesShipping AddressInsertChange Request WCH Cancer and Infusion Center 4704 Ambassador Caffery Pkwy Ste 300A Lafayette, LA 70508-69087/27/2021 7:19 AM
AddressesShipping AddressInsertChange Request Our Lady of Lourdes Infusion Pharmacy 4809 Ambassador Caffery Pkwy Ste 120 Lafayette, LA 70508-88007/27/2021 7:19 AM
AddressesShipping AddressInsertChange Request Our Lady of Lourdes Regional Medical Ctr. Pharmacy 4801 Ambassador Caffery Pkwy Lafayette, LA 70508-69177/16/2021 12:38 PM
Medicaid BillingMedicaid: NumberDeleteChange Request234773105 (AR) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request605746 (AZ) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request9000184002 (CO) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request18073200 (FL) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request600237 (IA) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300042829 (IN) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request220491 (MS) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1598766495 (MT) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1598766495 (NC) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange RequestQ032561 (TN) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request108822102 (TX) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request6701035 (VT) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100104641 (WI) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request720423635001 (IL) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request71000560190 (KY) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request200942370A (OK) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (AR) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (AZ) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (CO) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (FL) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (IA) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (IN) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (MS) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (MT) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (NC) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (TN) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (TX) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (VT) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (WI) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (IL) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (KY) 3/15/2021 3:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1598766495 (OK) 3/15/2021 3:25 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2021 2:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 7204236350013/15/2021 2:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IL3/15/2021 2:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2021 2:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 710005601903/15/2021 2:30 PM
Medicaid BillingMedicaid: StateInsertChange Request KY3/15/2021 2:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2021 2:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 200942370A3/15/2021 2:30 PM
Medicaid BillingMedicaid: StateInsertChange Request OK3/15/2021 2:30 PM
Medicaid BillingNPI: NumberInsertChange Request 15987664953/15/2021 2:30 PM
Medicaid BillingNPI: StateInsertChange Request IL3/15/2021 2:30 PM
Medicaid BillingNPI: NumberInsertChange Request 15987664953/15/2021 2:30 PM
Medicaid BillingNPI: StateInsertChange Request KY3/15/2021 2:30 PM
Medicaid BillingNPI: NumberInsertChange Request 15987664953/15/2021 2:30 PM
Medicaid BillingNPI: StateInsertChange Request OK3/15/2021 2:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 23477310512/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request AR12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 60574612/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 900018400212/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request CO12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 1807320012/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request FL12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 60023712/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request IA12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 30004282912/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request IN12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 22049112/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request MS12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request MT12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request NC12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request Q03256112/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request TN12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10882210212/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request TX12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 670103512/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request VT12/14/2020 11:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/14/2020 11:16 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10010464112/14/2020 11:16 AM
Medicaid BillingMedicaid: StateInsertChange Request WI12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request AR12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request AZ12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request CO12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request FL12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request IA12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request IN12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request MS12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request MT12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request NC12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request TN12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request TX12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request VT12/14/2020 11:16 AM
Medicaid BillingNPI: NumberInsertChange Request 159876649512/14/2020 11:16 AM
Medicaid BillingNPI: StateInsertChange Request WI12/14/2020 11:16 AM
Medicaid BillingNPI: StateUpdateRecertification LA8/18/2020 1:50 PM
DetailsLast Recertification DateUpdateRecertification 8/18/2020 1:50:51 PM8/18/2020 1:50 PM
DetailsStateUpdate ApprovedActive1/1/2020 12:04 AM
ContactsAuthorizing OfficialUpdateReinstatementWilson, Monte Chief Operating Officer 3374702100Kiser, Crystal R Manager Our Lady of Lourdes Regional Medical Center 337470213111/15/2019 1:50 PM
ContactsSigned ByUpdateReinstatementHebert, Kim L. VP of Finance & CFO 3374704380Kiser, Crystal R Manager Our Lady of Lourdes Regional Medical Center 337470213111/15/2019 1:50 PM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement7/1/2013 12:00:00 AM 11/15/2019 1:50 PM
DetailsEntity NameUpdateReinstatementOUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INCOUR LADY OF LOURDES RMC11/15/2019 1:50 PM
DatesParticipating Approval DateUpdateReinstatement2/22/2012 12:00:00 AM11/15/2019 1:50:53 PM11/15/2019 1:50 PM
DetailsStateUpdateReinstatementTerminatedApproved11/15/2019 1:50 PM
DatesRegistration DateUpdateReinstatement2/1/2012 12:00:00 AM10/1/2019 3:15:58 PM11/15/2019 1:50 PM
DatesSigned By DateUpdateReinstatement2/1/2012 12:00:00 AM10/23/2019 11:44:51 AM11/15/2019 1:50 PM
DatesStart DateUpdateReinstatement4/1/2012 12:00:00 AM1/1/2020 12:00:00 AM11/15/2019 1:50 PM
TerminationsTermination CommentsUpdateReinstatement reported DSH percentage below statutory minimum 11/15/2019 1:50 PM
TerminationsTermination DateUpdateReinstatement7/1/2013 12:00:00 AM 11/15/2019 1:50 PM
TerminationsTermination Effective DateUpdateReinstatement7/1/2013 12:00:00 AM 11/15/2019 1:50 PM
TerminationsTermination ReasonUpdateReinstatementDSH percentage below statutory minimum 11/15/2019 1:50 PM
DetailsComments PublicInsertReinstatement Participated starting 4/1/2012, terminated 7/1/2013. Reinstated 1/1/2020.10/24/2019 1:24 PM
AddressesMain AddressUpdateReinstatement 4801 AMBASSADOR CAFFERY PARKWAY LAFAYETTE, LA 70508 4801 AMBASSADOR CAFFERY PRKWY LAFAYETTE, LA 7050810/1/2019 7:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/1/2019 7:15 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 172044510/1/2019 7:15 PM
Medicaid BillingMedicaid: StateInsertReinstatement LA10/1/2019 7:15 PM
Medicaid BillingNPI: NumberInsertReinstatement 159876649510/1/2019 7:15 PM
DatesLast Date That 340B Drugs PurchasedUpdate  7/1/2013 12:00:00 AM8/21/2019 10:55 AM
DatesParticipating Approval DateUpdate  2/22/2012 12:00:00 AM8/21/2019 10:55 AM
DetailsStateUpdate PendingTerminated8/21/2019 10:55 AM
DatesRegistration DateUpdate 7/12/2019 12:02:35 PM2/1/2012 12:00:00 AM8/21/2019 10:55 AM
DatesStart DateUpdate  4/1/2012 12:00:00 AM8/21/2019 10:55 AM
TerminationsTermination CommentsUpdate   reported DSH percentage below statutory minimum8/21/2019 10:55 AM
TerminationsTermination DateUpdate  7/1/2013 12:00:00 AM8/21/2019 10:55 AM
TerminationsTermination Effective DateUpdate  7/1/2013 12:00:00 AM8/21/2019 10:55 AM
TerminationsTermination ReasonUpdate  DSH percentage below statutory minimum8/21/2019 10:55 AM
ContactsPrimary ContactUpdate Broussard, Edward L. Director of Pharmacy 3374702111Broussard, Edward L. Director of Pharmacy Our Lady of Lourdes Regional Medical Center 33747021117/12/2019 12:02 PM
DatesLast Date That 340B Drugs PurchasedUpdate 7/1/2013 12:00:00 AM 7/12/2019 12:02 PM
DatesParticipating Approval DateUpdate 2/22/2012 12:00:00 AM 7/12/2019 12:02 PM
DetailsStateUpdate TerminatedPending7/12/2019 12:02 PM
DatesRegistration DateUpdate 2/1/2012 12:00:00 AM7/12/2019 12:02:35 PM7/12/2019 12:02 PM
DatesStart DateUpdate 4/1/2012 12:00:00 AM 7/12/2019 12:02 PM
TerminationsTermination CommentsUpdate  reported DSH percentage below statutory minimum 7/12/2019 12:02 PM
TerminationsTermination DateUpdate 7/1/2013 12:00:00 AM 7/12/2019 12:02 PM
TerminationsTermination Effective DateUpdate 7/1/2013 12:00:00 AM 7/12/2019 12:02 PM
TerminationsTermination ReasonUpdate DSH percentage below statutory minimum 7/12/2019 12:02 PM
ContactsSigned ByInsert  Hebert, Kim L. VP of Finance & CFO 33747043807/3/2014 4:20 PM
ContactsAuthorizing OfficialInsert  Wilson, Monte Chief Operating Officer 33747021007/3/2014 4:20 PM
ContactsPrimary ContactInsert  Broussard, Edward L. Director of Pharmacy 33747021117/3/2014 4:20 PM
DatesLast Date That 340B Drugs PurchasedUpdate  7/1/2013 12:00:00 AM7/3/2014 4:20 PM
TerminationsTermination CommentsUpdate   reported DSH percentage below statutory minimum7/3/2014 4:20 PM
TerminationsTermination Effective DateUpdate  7/1/2013 12:00:00 AM7/3/2014 4:20 PM
AddressesMain AddressInsert   4801 AMBASSADOR CAFFERY PARKWAY LAFAYETTE, LA 705084/29/2013 4:51 PM
DetailsStateUpdate ActiveTerminated4/29/2013 4:51 PM
TerminationsTermination DateUpdate  7/1/2013 12:00:00 AM4/29/2013 4:51 PM
TerminationsTermination ReasonUpdate  DSH percentage below statutory minimum4/29/2013 4:51 PM
Details340B IDUpdate IS-JH-DSH190102DSH1901022/22/2012 11:02 AM
DatesParticipating Approval DateUpdate  2/22/2012 12:00:00 AM2/22/2012 11:02 AM
DetailsStateUpdate PendingActive2/22/2012 11:02 AM
DatesStart DateUpdate  4/1/2012 12:00:00 AM2/22/2012 11:02 AM
Details340B IDUpdate JH020212IS-JH-DSH1901022/7/2012 1:46 PM
Details340B IDUpdate ONLINE_REGJH0202122/2/2012 10:08 AM
DetailsLast Recertification DateInsert   2/1/2012 11:43 AM
DetailsGrant NumberInsert   2/1/2012 11:43 AM
Details340B IDInsert  ONLINE_REG2/1/2012 11:43 AM
DetailsIs Authorizing Official EHB DataInsert   2/1/2012 11:43 AM
DatesLast Date That 340B Drugs PurchasedInsert   2/1/2012 11:43 AM
DetailsMedicare Provider NumberInsert  1901022/1/2012 11:43 AM
DetailsEntity NameInsert  OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC2/1/2012 11:43 AM
DetailsProgram CodeInsert  DSH2/1/2012 11:43 AM
DetailsEntity SubnameInsert   2/1/2012 11:43 AM
DatesParticipating Approval DateInsert   2/1/2012 11:43 AM
DetailsStateInsert  Pending2/1/2012 11:43 AM
DatesRegistration DateInsert  2/1/2012 12:00:00 AM2/1/2012 11:43 AM
DatesSigned By DateInsert  2/1/2012 12:00:00 AM2/1/2012 11:43 AM
DatesStart DateInsert   2/1/2012 11:43 AM
TerminationsTermination CommentsInsert   2/1/2012 11:43 AM
TerminationsTermination DateInsert   2/1/2012 11:43 AM
TerminationsTermination Effective DateInsert   2/1/2012 11:43 AM
TerminationsTermination ReasonInsert   2/1/2012 11:43 AM