Covered Entity Details

DSH190040B Slidell Memorial Hospital (Active) - information as of 4/25/2025 8:34:31 PM

Main Details

Name

Slidell Memorial Hospital

Subdivision Name

SMH Imaging-MRI

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190040B

Medicare Provider Number

190040

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/28/2016

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Slidell Memorial Hospital
Sandy T Badinger, CEO
(504) 881-7056

Primary Contact

Slidell Memorial Hospital
Kisha Gant O'Neal Gant, Director of Pharmacy
(985) 280-7667

Addresses

Street Address

1495 Gause Blvd
Slidell, LA 70458

Billing Address

Ochsner Clinic Foundation - Accounts Payable
1201 Dickory Ave
New Orleans, LA 70123

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	1720313	1578568481
MS	00020424	1578568481

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
DSH190040A	Child	DSH	Slidell Memorial Hospital	Slidell Memorial Hospital Regional Cancer Center	1120 Robert Blvd.	Slidell	LA	Active
DSH190040AA	Child	DSH	Slidell Memorial Hospital	Physical Therapy MC07 - SMEH PHYSICAL THERAPY	100 Medical Center Drive	Slidell	LA	Active
DSH190040AB	Child	DSH	Slidell Memorial Hospital	Electrocardiology MC07 - SMEH EKG/CARDIOLOGY	100 Medical Center Drive	Slidell	LA	Active
DSH190040AC	Child	DSH	Slidell Memorial Hospital	Cardiac Rehab - SMHH CARDIO PULMONARY REHAB	1051 Gause Boulevard	Slidell	LA	Active
DSH190040AD	Child	DSH	Slidell Memorial Hospital	Emergency Med Svcs MC07 - SMEH EMERGENCY DEPARTMENT	100 Medical Center Drive	Slidell	LA	Active
DSH190040AE	Child	DSH	Slidell Memorial Hospital	Wound Care MC08 - SMEH WOUND CARE	100 Medical Center Drive	Slidell	LA	Active
DSH190040AF	Child	DSH	Slidell Memorial Hospital	CT Scan MC07 - SMEH CT SCAN	100 Medical Center Drive	Slidell	LA	Active
DSH190040AG	Child	DSH	Slidell Memorial Hospital	Ultrasonography MC07 - SMEH ULTRASOUND	100 Medical Center Drive	Slidell	LA	Active
DSH190040AH	Child	DSH	Slidell Memorial Hospital	Mammography MC07 - SMEH MAMMOGRAPHY	100 Medical Center Drive	Slidell	LA	Active
DSH190040AJ	Child	DSH	Slidell Memorial Hospital	MRI MC07 - SMEH MRI	100 Medical Center Drive	Slidell	LA	Active
DSH190040AK	Child	DSH	Slidell Memorial Hospital	Nuclear Medicine MC07 - SMEH NUCLEAR MEDICINE	100 Medical Center Drive	Slidell	LA	Active
DSH190040B	Child	DSH	Slidell Memorial Hospital	SMH Imaging-MRI	1495 Gause Blvd	Slidell	LA	Active
DSH190040D	Child	DSH	Slidell Memorial Hospital	Radiology-Diagnostic	1495 GAUSE BLVD	SLIDELL	LA	Active
DSH190040E	Child	DSH	Slidell Memorial Hospital	SMH PRIMARY CARE - Primary Care Clinic	901 GAUSE BLVD	SLIDELL	LA	Terminated
DSH190040F	Child	DSH	Slidell Memorial Hospital	CARDIOLOGY OUTPATIENT DIAGNOSTICS - CARDIOLOGY OUTPATIENT DIAGNOSTICS	1051 GAUSE BLVD	SLIDELL	LA	Active
DSH190040G	Child	DSH	Slidell Memorial Hospital	SMH Imaging CT Scan - SMHH CT SCAN IMAGING CENTER	1495 Gause Boulevard	Slidell	LA	Active
DSH190040H	Child	DSH	Slidell Memorial Hospital	OP Surgery Center MC04 - SMEH ASU PERIOP SERVICES	100 Medical Center Drive	Slidell	LA	Active
DSH190040J	Child	DSH	Slidell Memorial Hospital	Outpatient Surgery MC07 - SMEH PRE/POST-OP	100 Medical Center Drive	Slidell	LA	Active
DSH190040K	Child	DSH	Slidell Memorial Hospital	Endoscopy MC07 - SMEH ENDOSCOPY	100 Medical Center Drive	Slidell	LA	Active
DSH190040L	Child	DSH	Slidell Memorial Hospital	Surg & Recovery Svcs MC07 - SMEH PERIOP SERVICES	100 Medical Center Drive	Slidell	LA	Active
DSH190040M	Child	DSH	Slidell Memorial Hospital	Post Anest Care Unit MC07 - SMEH PACU	100 Medical Center Drive	Slidell	LA	Active
DSH190040N	Child	DSH	Slidell Memorial Hospital	Anesthesiology MC07 - SMEH ANESTHESIOLOGY	100 Medical Center Drive	Slidell	LA	Active
DSH190040P	Child	DSH	Slidell Memorial Hospital	Radiology Intervent MC07 - SMEH INTERVENTIONAL RADIOLOGY	100 Medical Center Drive	Slidell	LA	Active
DSH190040Q	Child	DSH	Slidell Memorial Hospital	Radiology Diagnostic MC07 - SMEH XRAY	100 Medical Center Drive	Slidell	LA	Active
DSH190040R	Child	DSH	Slidell Memorial Hospital	SMH Imaging PET Scan - SMHH PET CT IMAGING CENTER	1495 Gause Boulevard	Slidell	LA	Active
DSH190040S	Child	DSH	Slidell Memorial Hospital	SMH Imaging Radiology - SMHH XRAY IMAGING CENTER	1495 Gause Boulevard	Slidell	LA	Active
DSH190040T	Child	DSH	Slidell Memorial Hospital	SMH Imaging Ultrasound - SMHH ULTRASOUND IMAGING CENTER	1495 Gause Boulevard	Slidell	LA	Active
DSH190040U	Child	DSH	Slidell Memorial Hospital	Laboratory - SMHH IMAGING LAB DRAW STATION	1495 Gause Boulevard	Slidell	LA	Active
DSH190040V	Child	DSH	Slidell Memorial Hospital	Infusion MC07 - SMEH INFUSION	100 Medical Center Drive	Slidell	LA	Active
DSH190040W	Child	DSH	Slidell Memorial Hospital	Pulmonary Funct Svcs MC07 - SMEH PULMONARY FUNCTION SERVICES	100 Medical Center Drive	Slidell	LA	Active
DSH190040X	Child	DSH	Slidell Memorial Hospital	Respiratory Therapy MC07 - SMEH RESPIRATORY THERAPY	100 Medical Center Drive	Slidell	LA	Active
DSH190040Y	Child	DSH	Slidell Memorial Hospital	Occupational Med MC07 - SMEH OCCUPATIONAL THERAPY	100 Medical Center Drive	Slidell	LA	Active
DSH190040Z	Child	DSH	Slidell Memorial Hospital	Speech Lang Path MC07 - SMEH SPEECH THERAPY	100 Medical Center Drive	Slidell	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:17:27 PM	8/27/2024 6:37:32 PM	8/27/2024 6:37 PM
Addresses	Billing Address	Insert	Change Request		Ochsner Clinic Foundation - Accounts Payable 1201 Dickory Ave New Orleans, LA 70123	4/30/2024 1:57 PM
Contacts	Primary Contact	Update	Group Change Request	Gant, Kisha Pharmacy Director Slidell Memorial Hospital 9852808898	Gant, Kisha Gant O'Neal Director of Pharmacy Slidell Memorial Hospital 9852807667	4/25/2024 2:00 PM
Contacts	Authorizing Official	Update	AO Change Request	Badinger, Sandy Chief Executive Officer Slidell Memorial Hospital 9852808503	Badinger, Sandy T CEO Slidell Memorial Hospital 5048817056	4/19/2024 2:13 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 4:32:40 PM	8/14/2023 2:17:27 PM	8/14/2023 2:17 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 12:28:33 PM	9/1/2022 4:32:40 PM	9/1/2022 4:32 PM
Addresses	Shipping Address	Delete	Recertification	Slidell Memorial Hospital 1001 Gause Blvd Slidell, LA 70458		8/24/2021 12:28 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 1:51:06 PM	8/24/2021 12:28:33 PM	8/24/2021 12:28 PM
Contacts	Authorizing Official	Update	Profile Change Request	Badinger, Sandy Chief Financial Officer Slidell Memorial Hospital 9852808503	Badinger, Sandy Chief Executive Officer Slidell Memorial Hospital 9852808503	8/27/2020 7:26 PM
Contacts	Signed By	Update	Profile Change Request	Badinger, Sandy Chief Financial Officer Slidell Memorial Hospital 9852808503	Badinger, Sandy Chief Executive Officer Slidell Memorial Hospital 9852808503	8/27/2020 7:26 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578568481	8/21/2020 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/21/2020 1:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578568481	8/21/2020 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/21/2020 1:51 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1578568481 ( )		8/21/2020 1:51 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 3:09:09 PM	8/21/2020 1:51:06 PM	8/21/2020 1:51 PM
Contacts	Primary Contact	Update	Change Request	McKendall, Michael Director of Pharmacy Slidell Memorial Hospital 9852808898	Gant, Kisha Pharmacy Director Slidell Memorial Hospital 9852808898	10/8/2019 12:26 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 1:53:05 PM	8/20/2019 3:09:09 PM	8/20/2019 3:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578568481	8/17/2018 1:53 PM
Details	Last Recertification Date	Update	Recertification	11/13/2017 12:43:53 PM	8/17/2018 1:53:05 PM	8/17/2018 1:53 PM
Details	Last Recertification Date	Update	Recertification	10/24/2017 11:02:11 AM	11/13/2017 12:43:53 PM	11/13/2017 12:43 PM
Details	Entity Name	Update	Recertification	SLIDELL MEMORIAL HOSPITAL	Slidell Memorial Hospital	10/24/2017 11:03 AM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	10/24/2017 11:02:11 AM	10/24/2017 11:02 AM
Contacts	Authorizing Official	Update		Badinger, Sandy Chief Financial Officer 9852808503	Badinger, Sandy Chief Financial Officer Slidell Memorial Hospital 9852808503	10/11/2017 2:08 PM
Contacts	Signed By	Update		Badinger, Sandy Chief Financial Officer 9852808503	Badinger, Sandy Chief Financial Officer Slidell Memorial Hospital 9852808503	10/11/2017 2:08 PM
Contacts	Primary Contact	Update		McKendall, Michael Director of Pharmacy 9852808898	McKendall, Michael Director of Pharmacy Slidell Memorial Hospital 9852808898	10/9/2017 10:04 AM
Addresses	Main Address	Insert			1495 Gause Blvd Slidell, LA 70458	8/12/2016 10:23 AM
Contacts	Primary Contact	Insert			McKendall, Michael Director of Pharmacy 9852808898	8/12/2016 10:23 AM
Contacts	Authorizing Official	Insert			Badinger, Sandy Chief Financial Officer 9852808503	8/12/2016 10:23 AM
Contacts	Signed By	Insert			Badinger, Sandy Chief Financial Officer 9852808503	8/12/2016 10:23 AM
Details	Last Recertification Date	Update			8/12/2016 12:00:00 AM	8/12/2016 10:23 AM
Addresses	Shipping Address	Insert			Slidell Memorial Hospital 1001 Gause Blvd Slidell, LA 70458	6/15/2016 10:15 PM
Dates	Participating Approval Date	Update			4/28/2016 12:00:00 AM	4/28/2016 4:13 PM
Details	State	Update		Pending	Active	4/28/2016 4:13 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/28/2016 4:13 PM
Details	Entity Subname	Update		SMH Imaging	SMH Imaging-MRI	4/26/2016 11:01 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_60652	DSH190040B	4/26/2016 10:27 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_60652	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: Number	Insert			1720313	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: State	Insert			LA	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: Number	Insert			00020424	4/15/2016 4:29 PM
Medicaid Billing	Medicaid: State	Insert			MS	4/15/2016 4:29 PM
Details	Last Recertification Date	Insert				4/15/2016 4:29 PM
Details	Grant Number	Insert				4/15/2016 4:29 PM
Details	340B ID	Insert				4/15/2016 4:29 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2016 4:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2016 4:29 PM
Details	Medicare Provider Number	Insert			190040	4/15/2016 4:29 PM
Details	Entity Name	Insert			SLIDELL MEMORIAL HOSPITAL	4/15/2016 4:29 PM
Details	Program Code	Insert			DSH	4/15/2016 4:29 PM
Details	Entity Subname	Insert			SMH Imaging	4/15/2016 4:29 PM
Dates	Participating Approval Date	Insert				4/15/2016 4:29 PM
Details	State	Insert			Pending	4/15/2016 4:29 PM
Dates	Registration Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 4:29 PM
Dates	Signed By Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 4:29 PM
Dates	Start Date	Insert				4/15/2016 4:29 PM
Terminations	Termination Comments	Insert				4/15/2016 4:29 PM
Terminations	Termination Date	Insert				4/15/2016 4:29 PM
Terminations	Termination Effective Date	Insert				4/15/2016 4:29 PM
Terminations	Termination Reason	Insert				4/15/2016 4:29 PM