Covered Entity Details

DSH190046AB TOURO INFIRMARY (Terminated) - information as of 6/12/2025 9:48:17 PM

Main Details

Name

TOURO INFIRMARY

Subdivision Name

CCPI HEMATOLOGY AND ONCOLOGY - Hematology and Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190046AB

Medicare Provider Number

190046

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/16/2017

Participating Start Date

1/1/2018

Participating Approval Date

10/24/2017

Last Recertification Date

9/5/2023

Termination Date
Termination Reason

10/1/2024
Site closure

Contacts

Authorizing Official

Touro Infirmary
Stephen Matthew Baldwin, Chief Operating Officer
(504) 897-8566

Primary Contact

Touro Infirmary
Tara Montgomery, Director of Pharmacy
(504) 897-8071 Ext: 7515

Addresses

Street Address

3712 Mac Arthur Blvd.
STE 103
New Orleans, LA 70114-6865

Billing Address

Touro Infirmary
1401 Foucher Street
New Orleans, LA 70115

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	1720470	1821098286

Shipping Addresses

Shipping Address 1

Touro Infirmary
1401 Foucher Street
New Orleans, LA 70115

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
DSH190046AA	Child	DSH	TOURO INFIRMARY	CCPI FAMILY PRACTICE & OBGYN - Hematology and Oncology	145 ROBERT E LEE BLVD	NEW ORLEANS	LA	Terminated
DSH190046AB	Child	DSH	TOURO INFIRMARY	CCPI HEMATOLOGY AND ONCOLOGY - Hematology and Oncology	3712 Mac Arthur Blvd.	New Orleans	LA	Terminated
DSH190046AC	Child	DSH	TOURO INFIRMARY	Internal Medicine - Internal Medicine	3525 Prytania Street	New Orleans	LA	Terminated
DSH190046AD	Child	DSH	TOURO INFIRMARY	Ridgelake 4th Floor - Oncology Infusion Clinic	2121 Ridgelake Drive	Metairie	LA	Active
DSH190046AE	Child	DSH	TOURO INFIRMARY	TOURO MATERNAL FETAL MEDICINE CLINI - Maternal Fetal Medicine Clinic	3700 SAINT CHARLES AVE	NEW ORLEANS	LA	Approved
DSH190046AF	Child	DSH	TOURO INFIRMARY	TOURO PRYTANIA IMAGING CENTER - Prytania Imaging Center	3437 PRYTANIA ST	NEW ORLEANS	LA	Approved
DSH190046C	Child	DSH	TOURO INFIRMARY	Internal Medicine and OBGYN	4000 Bienville Street	New Orleans	LA	Terminated
DSH190046D	Child	DSH	TOURO INFIRMARY	Family Practice and OBGYN	145 Robert E Lee BLVD	New Orleans	LA	Terminated
DSH190046E	Child	DSH	TOURO INFIRMARY	Family Practice and OBGYN	3322 St.Claude Ave	New Orleans	LA	Terminated
DSH190046F	Child	DSH	TOURO INFIRMARY	Internal Medicine Cardiology and OBGYN	3712 Mac Arthur Blvd	New Orleans	LA	Terminated
DSH190046G	Child	DSH	TOURO INFIRMARY	Internal Medicine, Cardiovascular, Family Practice and OBGYN	5646 Read BLVD	New Orleans	LA	Active
DSH190046H	Child	DSH	TOURO INFIRMARY	Cardiovascular	3715 Prytania STREET	New Orleans	LA	Active
DSH190046J	Child	DSH	TOURO INFIRMARY	Primary and Specialty	3434 Prytania Street, Suite 105	New Orleans	LA	Active
DSH190046K	Child	DSH	TOURO INFIRMARY	OBGYN	3434 Prytania Street, Suite 130	New Orleans	LA	Active
DSH190046M	Child	DSH	TOURO INFIRMARY	Internal Medicine	3434 Prytania Street Suite 460	New Orleans	LA	Active
DSH190046N	Child	DSH	TOURO INFIRMARY	Internal Medicine	3434 Prytania Street, Suite 110	New Orleans	LA	Active
DSH190046P	Child	DSH	TOURO INFIRMARY	OBGYN	3434 Prytania Street, Suite 320	New Orleans	LA	Active
DSH190046Q	Child	DSH	TOURO INFIRMARY	OBGYN	3525 Prytania Street, Suite 224	New Orleans	LA	Active
DSH190046R	Child	DSH	TOURO INFIRMARY	OBGYN	3525 Prytania Street, Suite 206	New Orleans	LA	Active
DSH190046S	Child	DSH	TOURO INFIRMARY	Touro Ambulatory Surgery Center	3525 Prytania Street, Suite 102	New Orleans	LA	Active
DSH190046T	Child	DSH	TOURO INFIRMARY	Touro Imaging Center	2929 Napoleon Ave.	New Orleans	LA	Active
DSH190046U	Child	DSH	TOURO INFIRMARY	Touro Head & Neck Clinic	3700 St. Charles Ave., Suite 700	New Orleans	LA	Terminated
DSH190046V	Child	DSH	TOURO INFIRMARY	Internal Medicine, OBGYN	701 Metairie Rd., Suite 1A-205	Metairie	LA	Active
DSH190046W	Child	DSH	TOURO INFIRMARY	CCPI UROLOGY	3434 Prytania St, Suite 450	New Orleans	LA	Active
DSH190046X	Child	DSH	TOURO INFIRMARY	CCPI INTERNAL MEDICINE	3525 PRYTANIA ST, SUITE 620	NEW ORLEANS	LA	Active
DSH190046Y	Child	DSH	TOURO INFIRMARY	General Surgery - General Surgery	5646 Read Blvd, Suite 280	New Orleans	LA	Active
DSH190046Z	Child	DSH	TOURO INFIRMARY	Gynecologic Oncology - Gynecologic Oncology	3434 Prytania Street	New Orleans	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/29/2023 12:00:00 AM	9/5/2024 7:39 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/5/2024 7:39 AM
Terminations	Termination Date	Update	Recertification		10/1/2024 12:00:00 AM	9/5/2024 7:39 AM
Terminations	Termination Effective Date	Update	Recertification		12/29/2023 12:00:00 AM	9/5/2024 7:39 AM
Terminations	Termination Reason	Update	Recertification		Site closure	9/5/2024 7:39 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 5:02:32 PM	9/5/2023 10:43:29 AM	9/5/2023 10:43 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	407357 (AZ)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	63136635 (NM)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1019836 (WA)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	197961548A (GA)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	220448 (MS)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	107848701 (TX)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	902734300 (FL)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1512664 (TN)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	226434661A (GA)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1821098286 (NC)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1821098286 (WI)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1821098286 (VA)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1025142 (VT)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	102252959 (PA)		9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1821098286 (NV)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (WA)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (PA)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (VT)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (TX)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (TN)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (NC)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (WI)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (VA)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (NV)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (MS)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (GA)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (AZ)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (NM)		9/8/2022 5:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 (FL)		9/8/2022 5:02 PM
Details	Last Recertification Date	Update	Recertification	9/9/2021 2:35:28 PM	9/8/2022 5:02:32 PM	9/8/2022 5:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		197961548A	9/9/2021 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/9/2021 2:35 PM
Details	Last Recertification Date	Update	Recertification	8/27/2020 7:58:50 AM	9/9/2021 2:35:28 PM	9/9/2021 2:35 PM
Addresses	Main Address	Update	Recertification	3712 MCARTHUR BLVD STE 103 NEW ORLEANS, LA 70114-6865	3712 Mac Arthur Blvd. STE 103 New Orleans, LA 70114-6865	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1821098286	8/27/2020 7:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/27/2020 7:58 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821098286 ( )		8/27/2020 7:58 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 2:54:38 PM	8/27/2020 7:58:50 AM	8/27/2020 7:58 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		407357	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		63136635	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NM	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1019836	9/9/2019 2:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	9/9/2019 2:54 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 11:35:26 AM	9/9/2019 2:54:38 PM	9/9/2019 2:54 PM
Contacts	Authorizing Official	Update	AO Change Request	Andrews, Susan President & CEO Touro Infirmary 5048978247	Baldwin, Stephen Matthew Chief Operating Officer Touro Infirmary 5048978566	2/26/2019 5:15 PM
Addresses	Shipping Address	Insert	Recertification		Touro Infirmary 1401 Foucher Street New Orleans, LA 70115	9/7/2018 11:35 AM
Details	Last Recertification Date	Update	Recertification		9/7/2018 11:35:26 AM	9/7/2018 11:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/11/2018 9:19 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1821098286	4/11/2018 9:19 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	4/11/2018 9:19 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Andrews, Susan President & CEO Touro Infirmary 5048978247	10/24/2017 9:38 AM
Details	340B ID	Update	New Registration		DSH190046AB	10/24/2017 9:38 AM
Details	Entity Subname	Update	New Registration	CCPI HEMATOLOGY AND ONCOLOGY	CCPI HEMATOLOGY AND ONCOLOGY - Hematology and Oncology	10/24/2017 9:38 AM
Dates	Participating Approval Date	Update	New Registration		10/24/2017 9:38:16 AM	10/24/2017 9:38 AM
Details	State	Update	New Registration	Pending	Approved	10/24/2017 9:38 AM
Dates	Signed By Date	Update	New Registration		10/16/2017 4:35:38 PM	10/24/2017 9:38 AM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	10/24/2017 9:38 AM
Addresses	Main Address	Insert	New Registration		3712 MCARTHUR BLVD STE 103 NEW ORLEANS, LA 70114-6865	10/16/2017 4:35 PM
Addresses	Billing Address	Insert	New Registration		Touro Infirmary 1401 Foucher Street New Orleans, LA 70115	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		220448	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		107848701	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		902734300	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1512664	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		226434661A	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1821098286	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1821098286	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WI	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1821098286	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1025142	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VT	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		102252959	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1720470	10/16/2017 4:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	10/16/2017 4:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821098286	10/16/2017 4:35 PM
Contacts	Authorizing Official	Insert	New Registration		Andrews, Susan President & CEO Touro Infirmary 5048978247	10/16/2017 4:35 PM
Contacts	Primary Contact	Insert	New Registration		Montgomery, Tara Director of Pharmacy Touro Infirmary 5048978071-7515	10/16/2017 4:35 PM
Details	Last Recertification Date	Insert	New Registration			10/16/2017 4:35 PM
Details	Grant Number	Insert	New Registration			10/16/2017 4:35 PM
Details	340B ID	Insert	New Registration			10/16/2017 4:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/16/2017 4:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/16/2017 4:35 PM
Details	Medicare Provider Number	Insert	New Registration		190046	10/16/2017 4:35 PM
Details	Entity Name	Insert	New Registration		TOURO INFIRMARY	10/16/2017 4:35 PM
Details	Program Code	Insert	New Registration		DSH	10/16/2017 4:35 PM
Details	Entity Subname	Insert	New Registration		CCPI HEMATOLOGY AND ONCOLOGY	10/16/2017 4:35 PM
Dates	Participating Approval Date	Insert	New Registration			10/16/2017 4:35 PM
Details	State	Insert	New Registration		Pending	10/16/2017 4:35 PM
Dates	Registration Date	Insert	New Registration		10/16/2017 4:35:35 PM	10/16/2017 4:35 PM
Dates	Signed By Date	Insert	New Registration			10/16/2017 4:35 PM
Dates	Start Date	Insert	New Registration			10/16/2017 4:35 PM
Terminations	Termination Comments	Insert	New Registration			10/16/2017 4:35 PM
Terminations	Termination Date	Insert	New Registration			10/16/2017 4:35 PM
Terminations	Termination Effective Date	Insert	New Registration			10/16/2017 4:35 PM
Terminations	Termination Reason	Insert	New Registration			10/16/2017 4:35 PM