| Contacts | Authorizing Official | Update | AO Change Request | Calhoun, Robert McLucas
CEO
West Jefferson Medical Center
5043496659 | Miller, Chad
CFO
West Jefferson Medical Center
5043496021 | 11/7/2024 7:25 AM |
| Contacts | Primary Contact | Update | PC Change Request | Williams, Leigh-Ann S.
340B Analyst
West Jefferson Medical Center
5043491700-6932 | JacksonBrown, Cheryl L
Phamacy Director
West Jefferson Medical Center
5043491700 | 8/30/2024 8:13 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2023 11:26:54 AM | 8/13/2024 11:33:38 AM | 8/13/2024 11:33 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Williams, Leigh-Ann S.
340B Program Coordinator
West Jefferson Medical Center
5043491700-6932 | Williams, Leigh-Ann S.
340B Analyst
West Jefferson Medical Center
5043491700-6932 | 2/2/2024 2:32 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2022 9:06:19 AM | 9/8/2023 11:26:54 AM | 9/8/2023 11:26 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Smith, Robert Eli
Chief Operating Officer—West Jefferson Medical Center
West Jefferson Medical Center
5043491105 | Calhoun, Robert McLucas
CEO
West Jefferson Medical Center
5043496659 | 1/6/2023 7:43 AM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2021 10:17:53 AM | 8/31/2022 9:06:19 AM | 8/31/2022 9:06 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2020 5:54:00 PM | 9/9/2021 10:17:53 AM | 9/9/2021 10:17 AM |
| Contacts | Primary Contact | Update | Contract Pharmacy Registration | Williams, Leigh-Ann S.
340B Program Coordinator
West Jefferson Medical Center
5043491700 | Williams, Leigh-Ann S.
340B Program Coordinator
West Jefferson Medical Center
5043491700-6932 | 7/8/2021 3:26 PM |
| Contacts | Primary Contact | Update | Change Request | Higdon, April E.
Director of Pharmacy
West Jefferson Medical Center - Marrero, LA
5043491711 | Williams, Leigh-Ann S.
340B Program Coordinator
West Jefferson Medical Center
5043491700 | 3/24/2021 8:47 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | LA | 8/27/2020 5:54 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2019 12:38:45 PM | 8/27/2020 5:54:00 PM | 8/27/2020 5:54 PM |
| Contacts | Authorizing Official | Update | Change Request | McElmurray, Dodie
COO
West Jefferson Medical Center
5043496021 | Smith, Robert Eli
Chief Operating Officer—West Jefferson Medical Center
West Jefferson Medical Center
5043491105 | 4/14/2020 8:52 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/23/2019 12:38:45 PM | 8/23/2019 12:38 PM |
| Contacts | Primary Contact | Update | Change Request | RODGERS, LOVIE
DIRECTOR OF PHARMACEUTICAL SERVICES
West Jefferson Medical Center
5043491703-5043491711 | Higdon, April E.
Director of Pharmacy
West Jefferson Medical Center - Marrero, LA
5043491711 | 7/3/2019 7:42 AM |
| Contacts | Authorizing Official | Update | Change Request | Cassagne, Nancy
Chief Executive Officer
West Jefferson Medical Center
5043491100 | McElmurray, Dodie
COO
West Jefferson Medical Center
5043496021 | 3/28/2019 5:50 PM |
| Details | State | Update | | Approved | Active | 1/1/2019 12:05 AM |
| Addresses | Main Address | Insert | New Registration | |
1111 MEDICAL CENTER BLVD
S850
MARRERO, LA 70072 | 11/27/2018 10:27 AM |
| Addresses | Billing Address | Insert | New Registration | | WEST JEFFERSON MEDICAL CENTER
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072 | 11/27/2018 10:27 AM |
| Contacts | Signed By | Insert | New Registration | | Cassagne, Nancy
Chief Executive Officer
West Jefferson Medical Center
5043491100 | 11/27/2018 10:27 AM |
| Details | 340B ID | Update | New Registration | | DSH190039M | 11/27/2018 10:27 AM |
| Details | Entity Name | Update | New Registration | WEST JEFFERSON MEDICAL CENTER | WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER | 11/27/2018 10:27 AM |
| Details | Entity Subname | Update | New Registration | WEST JEFFERSON FAMILY DOCTORS | WEST JEFFERSON FAMILY DOCTORS - POB S850 FAMILY MEDICINE | 11/27/2018 10:27 AM |
| Dates | Participating Approval Date | Update | New Registration | | 11/27/2018 10:27:54 AM | 11/27/2018 10:27 AM |
| Details | State | Update | New Registration | Pending | Approved | 11/27/2018 10:27 AM |
| Dates | Signed By Date | Update | New Registration | | 10/12/2018 11:15:06 AM | 11/27/2018 10:27 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2019 12:00:00 AM | 11/27/2018 10:27 AM |
| Addresses | Main Address | Insert | New Registration | |
1111 MEDICAL CENTER BLVD
S850
MARRERO, LA 70072 | 10/3/2018 6:09 PM |
| Addresses | Billing Address | Insert | New Registration | | WEST JEFFERSON MEDICAL CENTER
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072 | 10/3/2018 6:09 PM |
| Addresses | Shipping Address | Insert | New Registration | | WEST JEFFERSON MEDICAL CENTER
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072 | 10/3/2018 6:09 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/3/2018 6:09 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1732788 | 10/3/2018 6:09 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | LA | 10/3/2018 6:09 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1265437644 | 10/3/2018 6:09 PM |
| Contacts | Primary Contact | Insert | New Registration | | RODGERS, LOVIE
DIRECTOR OF PHARMACEUTICAL SERVICES
West Jefferson Medical Center
5043491703-5043491711 | 10/3/2018 6:09 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Cassagne, Nancy
Chief Executive Officer
West Jefferson Medical Center
5043491100 | 10/3/2018 6:09 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Details | Grant Number | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Details | 340B ID | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 190039 | 10/3/2018 6:09 PM |
| Details | Entity Name | Insert | New Registration | | WEST JEFFERSON MEDICAL CENTER | 10/3/2018 6:09 PM |
| Details | Program Code | Insert | New Registration | | DSH | 10/3/2018 6:09 PM |
| Details | Entity Subname | Insert | New Registration | | WEST JEFFERSON FAMILY DOCTORS | 10/3/2018 6:09 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Details | State | Insert | New Registration | | Pending | 10/3/2018 6:09 PM |
| Dates | Registration Date | Insert | New Registration | | 10/3/2018 6:09:42 PM | 10/3/2018 6:09 PM |
| Dates | Signed By Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Dates | Start Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Terminations | Termination Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/3/2018 6:09 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/3/2018 6:09 PM |