Covered Entity Details

DSH190005G University Medical Center Management Corporation d/b/a Interim LSU Hospital (Terminated) - information as of 4/29/2025 1:42:51 AM

Main Details

Name

University Medical Center Management Corporation d/b/a Interim LSU Hospital

Subdivision Name

Diabetes Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190005G

Medicare Provider Number

190005

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/3/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/17/2013

Last Recertification Date

8/19/2015

Termination Date
Termination Reason

1/1/2016
Site closure

Contacts

Authorizing Official

UMCNO
Lisa Miranda, Chief Operating Officer
(504) 702-4411

Primary Contact

Anthony Laurent, Pharmacy Director
(504) 903-3022

Addresses

Street Address

1400 Poydras St.
New Orleans, LA 70112

Billing Address

University Medical Center Management Corporation d/b/a Interim LSU Hospital
2021 Perdido St.
New Orleans, LA 70112

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	1765651,1235369
		1568403111

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
DSH190005A	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Lord & Taylor Clinic	1400 POYDRAS STREET- 1ST FLOOR	NEW ORLEANS	LA	Terminated
DSH190005B	Child	DSH	University Medical Center Managment Corporation d/b/a Interim LSU Hospital	MCLNO HIV Outpatient Clinic	2235 Poydras Street	NEW ORLEANS	LA	Terminated
DSH190005C	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Coumadin Clinic	1400 Poydras St	New Orleans	LA	Terminated
DSH190005D	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Wound Care Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005E	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Medicine Subspecialty	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005F	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Medicine Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005G	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Diabetes Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005H	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Allergy Clinic	2021 Perdido St.	New Orleans	LA	Terminated
DSH190005J	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Ophthalmology Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005K	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	OB/GYN Clinic	2100 Perdido St.	New Orleans	LA	Terminated
DSH190005L	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Orthopedic Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005M	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Neurology Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005N	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Rehab Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005P	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Walk In Outpatient Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005Q	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Medical Home Poydras	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005R	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Landry Clinic	1200 L. B. Landry	New Orleans	LA	Terminated
DSH190005S	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Podiatry Clinic	1400 Poydras St.	New Orleans	LA	Terminated
DSH190005T	Child	DSH	University Medical Center Management Corporation d/b/a Interim LSU Hospital	Diabetes Education Center	1400 Poydras St	New Orleans	LA	Terminated
DSH190005U	Child	DSH	University Medical Center Management Corporation d/b/a University Medical Center New Orleans	Out-Patient Surgery Center - Out patient surgery	2000 Canal Street	New Orleans	LA	Active
DSH190005V	Child	DSH	University Medical Center Management Corporation d/b/a University Medical Center New Orleans	UMC OUTPATIENT BEHAVIORAL HEALTH - Behavioral Health	2475 CANAL ST	NEW ORLEANS	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Hardman, Danny CEO University Medical Center New Orleans 5047024418	Miranda, Lisa Chief Operating Officer UMCNO 5047024411	7/7/2020 11:23 AM
Contacts	Authorizing Official	Update	Change Request	Miranda, Lisa Chief Operating Officer UMCNO 5047024411	Hardman, Danny CEO University Medical Center New Orleans 5047024418	2/14/2020 8:03 AM
Contacts	Authorizing Official	Update	Profile Change Request	Miranda, Lisa SVP of Operations UMCNO 5047024411	Miranda, Lisa Chief Operating Officer UMCNO 5047024411	10/15/2019 5:59 PM
Contacts	Authorizing Official	Update		Miranda, Lisa SVP of Operations 5047024411	Miranda, Lisa SVP of Operations UMCNO 5047024411	9/22/2017 5:46 PM
Contacts	Authorizing Official	Insert			Miranda, Lisa SVP of Operations 5047024411	8/9/2017 10:56 AM
Contacts	Signed By	Insert			Nuesslein, Cindy CEO 5049034912	7/5/2017 3:56 PM
Contacts	Primary Contact	Update		Mornay, Conrad Director of Pharmacy 5049034016	Laurent, Anthony Pharmacy Director 5049033022	10/29/2015 12:37 PM
Dates	Last Date That 340B Drugs Purchased	Update			8/7/2015 12:00:00 AM	10/29/2015 12:35 PM
Details	State	Update		Active	Terminated	10/29/2015 12:35 PM
Terminations	Termination Comments	Update			Site moved to same address as covered entity. Site was terminated on 8/19/2015 during re-certification process, but did not go through properly.	10/29/2015 12:35 PM
Terminations	Termination Date	Update			1/1/2016 12:00:00 AM	10/29/2015 12:35 PM
Terminations	Termination Effective Date	Update			8/10/2015 12:00:00 AM	10/29/2015 12:35 PM
Terminations	Termination Reason	Update			Site closure	10/29/2015 12:35 PM
Addresses	Main Address	Insert			1400 Poydras St. New Orleans, LA 70112	10/29/2015 12:35 PM
Addresses	Billing Address	Insert			University Medical Center Management Corporation d/b/a Interim LSU Hospital 2021 Perdido St. New Orleans, LA 70112	10/29/2015 12:35 PM
Details	Last Recertification Date	Update		8/14/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 7:45 PM
Contacts	Primary Contact	Insert			Mornay, Conrad Director of Pharmacy 5049034016	8/14/2014 10:38 AM
Details	Last Recertification Date	Update			8/14/2014 12:00:00 AM	8/14/2014 9:31 AM
Dates	Participating Approval Date	Update			11/17/2013 12:00:00 AM	11/17/2013 7:00 AM
Details	State	Update		Pending	Active	11/17/2013 7:00 AM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/17/2013 7:00 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH190005G	10/22/2013 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2013 4:36 PM
Medicaid Billing	Medicaid: Number	Insert			1765651	10/3/2013 4:36 PM
Medicaid Billing	Medicaid: State	Insert			LA	10/3/2013 4:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2013 4:36 PM
Medicaid Billing	Medicaid: Number	Insert			1235369	10/3/2013 4:36 PM
Medicaid Billing	Medicaid: State	Insert			LA	10/3/2013 4:36 PM
Medicaid Billing	NPI: Number	Insert			1568403111	10/3/2013 4:36 PM
Details	Last Recertification Date	Insert				10/3/2013 4:36 PM
Details	Grant Number	Insert				10/3/2013 4:36 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/3/2013 4:36 PM
Details	Is Authorizing Official EHB Data	Insert				10/3/2013 4:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/3/2013 4:36 PM
Details	Medicare Provider Number	Insert			190005	10/3/2013 4:36 PM
Details	Entity Name	Insert			University Medical Center Management Corporation d/b/a Interim LSU Hospital	10/3/2013 4:36 PM
Details	Program Code	Insert			DSH	10/3/2013 4:36 PM
Details	Entity Subname	Insert			Diabetes Clinic	10/3/2013 4:36 PM
Dates	Participating Approval Date	Insert				10/3/2013 4:36 PM
Details	State	Insert			Pending	10/3/2013 4:36 PM
Dates	Registration Date	Insert			10/3/2013 12:00:00 AM	10/3/2013 4:36 PM
Dates	Signed By Date	Insert			10/3/2013 12:00:00 AM	10/3/2013 4:36 PM
Dates	Start Date	Insert				10/3/2013 4:36 PM
Terminations	Termination Comments	Insert				10/3/2013 4:36 PM
Terminations	Termination Date	Insert				10/3/2013 4:36 PM
Terminations	Termination Effective Date	Insert				10/3/2013 4:36 PM
Terminations	Termination Reason	Insert				10/3/2013 4:36 PM