340B Drug Pricing Program Database


DSH190064AW OUR LADY OF THE LAKE (Active) - information as of 4/30/2025 10:57:38 PM

Main Details
OUR LADY OF THE LAKE
OLOL STE - SLEEP LAB - SLEEP LAB
Disproportionate Share Hospital
No
DSH190064AW
190064


Additional Details
Active
4/12/2019
7/1/2019
5/24/2019
8/15/2024

Contacts

FMOLHS
Jennifer Clowers, Chief Financial Officer
(225) 765-8550

OUR LADY OF THE LAKE REGIONAL MED CTR
Thomas Greene, Senior Director of Pharmacy, Baton Rouge Market
(225) 765-8786

Addresses

1125 W Highway 30
Gonzales, LA 70737-5004

FMOLHS Accounts Payable
P.O. Box 83880
Baton Rouge, LA 70884


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
LA1720160,2202375,2205641,22070411740847771,1831605062,1215365341,1366436123
Shipping Addresses

Our Lady of the Lake St Elizabeth
1125 W Highway 30
Gonzales, LA 70737-5004
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH190064AAChildDSHOUR LADY OF THE LAKEOLOL Voice Center4950 Essen LaneBaton RougeLAActive
DSH190064ABChildDSHOUR LADY OF THE LAKEOLOL Head and Neck Center4950 Essen LaneBaton RougeLAActive
DSH190064ACChildDSHOUR LADY OF THE LAKEOLOL Hearing and Balance Center7777 Hennessy BlvdBaton RougeLAActive
DSH190064ADChildDSHOUR LADY OF THE LAKELake Imaging Center7135 Perkins RdBaton RougeLAActive
DSH190064AEChildDSHOUR LADY OF THE LAKEPediatric Physical Medicine Clinic8415 Goodwood BlvdBaton RougeLAActive
DSH190064AFChildDSHOUR LADY OF THE LAKEOLOL Sleep Center7777 Hennessy BlvdBaton RougeLAActive
DSH190064AGChildDSHOUR LADY OF THE LAKEOur Lady of the Lake Livingston 5000 O'Donavan BlvdWalkerLAActive
DSH190064AHChildDSHOUR LADY OF THE LAKELSU Health Imaging PSC / Imaging9032 Perkins RoadBaton RougeLAActive
DSH190064AJChildDSHOUR LADY OF THE LAKE REGIONAL MED CTRLake Main Campus-Advanced Imaging4950 ESSEN LANEBATON ROUGELATerminated
DSH190064AKChildDSHOUR LADY OF THE LAKEOUR LADY OF THE LAKE RHEUM SERVICES - Rheumatology7777 HENNESSEY BLVDBATON ROUGELAActive
DSH190064ALChildDSHOUR LADY OF THE LAKEOUR LADY OF THE LAKE WOUND AND HYPE - Wound Care7301 HENNESSY BLVDBATON ROUGELAActive
DSH190064AMChildDSHOUR LADY OF THE LAKEOur Lady of the Lake Urology Surgery7777 HennessyBaton RougeLAActive
DSH190064ANChildDSHOUR LADY OF THE LAKENorth ER - Emergency - Emergency Services5439 Airline HwyBaton RougeLAActive
DSH190064APChildDSHOUR LADY OF THE LAKE HOSPITAL, INC.OUR LADY OF THE LAKE INFUSION CENTE - Oncology500 RUE DE LA VIEBATON ROUGELATerminated
DSH190064AQChildDSHOUR LADY OF THE LAKELSU - Midcity Urgent Care - Urgent Care1401 N Foster DriveBaton RougeLAActive
DSH190064ARChildDSHOUR LADY OF THE LAKEOLOL STE - NEUROLOGY - NEUROLOGY1125 W Highway 30GonzalesLAActive
DSH190064ASChildDSHOUR LADY OF THE LAKEOLOL STE - SURGERY - ASC - SURGERY1014 Saint Clair BlvdGonzalesLAActive
DSH190064ATChildDSHOUR LADY OF THE LAKEOLOL STE - EMERGENCY ROOM - EMERGENCY SERVICES1125 W Highway 30GonzalesLAActive
DSH190064AUChildDSHOUR LADY OF THE LAKEOLOL STE - SURGERY - MAIN - SURGERY1125 W Highway 30GonzalesLAActive
DSH190064AVChildDSHOUR LADY OF THE LAKEOLOL STE - PHYSICAL MEDICINE - PHYSICAL MEDICINE1125 W Highway 30GonzalesLAActive
DSH190064AWChildDSHOUR LADY OF THE LAKEOLOL STE - SLEEP LAB - SLEEP LAB1125 W Highway 30GonzalesLAActive
DSH190064AXChildDSHOUR LADY OF THE LAKEOLOL STE - RADIOLOGY - IMAGING1125 W Highway 30GonzalesLAActive
DSH190064AYChildDSHOUR LADY OF THE LAKEOLOL STE - RESPIRATORY CARE - RESPIRATORY1125 W Highway 30GonzalesLAActive
DSH190064AZChildDSHOUR LADY OF THE LAKEObservation -OLOL STE - ICU - INTENSIVE CARE1125 W Highway 30GonzalesLATerminated
DSH190064BChildDSHOUR LADY OF THE LAKEFamily Practice Mid City Clinic1401 N Foster DriveBaton RougeLAActive
DSH190064BAChildDSHOUR LADY OF THE LAKEOLOL STE - WOUND CARE - WOUND CARE1125 W Highway 30GonzalesLAActive
DSH190064BBChildDSHOUR LADY OF THE LAKEObservation - OLOL STE - MEDICINE - MEDICINE1125 W Highway 30GonzalesLATerminated
DSH190064BCChildDSHOUR LADY OF THE LAKEObservation - OLOL STE - TELEMETRY - TELEMETRY1125 W Highway 30GonzalesLATerminated
DSH190064BDChildDSHOUR LADY OF THE LAKEObservation-OLOL STE - SURGERY UNIT - SURGERY1125 W Highway 30GonzalesLATerminated
DSH190064BEChildDSHOUR LADY OF THE LAKEOLOL STE - ENDOSCOPY - ENDOSCOPY1125 W Highway 30GonzalesLAActive
DSH190064BFChildDSHOUR LADY OF THE LAKELake Children's Hospital - Emergency Department - Emergency Services8300 Constantin BlvdBaton RougeLAActive
DSH190064BGChildDSHOUR LADY OF THE LAKELake Children's Hospital - Hematology/Oncology - Hematology & Oncology8300 Constantin BlvdBaton RougeLATerminated
DSH190064BHChildDSHOUR LADY OF THE LAKELake Children's Hospital - Physical Therapy - Physical Medicine8300 Constantin BlvdBaton RougeLAActive
DSH190064BJChildDSHOUR LADY OF THE LAKELake Children's Hospital - OR MAIN - Surgical Services8300 Constantin BlvdBaton RougeLAActive
DSH190064BKChildDSHOUR LADY OF THE LAKELake Children's Hospital - Surgical - Surgical Services8300 Constantin BlvdBaton RougeLATerminated
DSH190064BLChildDSHOUR LADY OF THE LAKE REGIONAL MED CTRLake Children's Hospital - Dialysis - Dialysis8300 Constantin BlvdBaton RougeLATerminated
DSH190064BMChildDSHOUR LADY OF THE LAKELake Children's Hospital - Wound Care - Wound Care8300 Constantin BlvdBaton RougeLAActive
DSH190064BNChildDSHOUR LADY OF THE LAKELake Children's Hospital - Radiology - Imaging Services8300 Constantin BlvdBaton RougeLAActive
DSH190064BPChildDSHOUR LADY OF THE LAKELake Children's Hospital - PACU - Recovery Room8300 Constantin BlvdBaton RougeLAActive
DSH190064BQChildDSHOUR LADY OF THE LAKELake Children's Hospital - Preop - Surgical Services8300 Constantin BlvdBaton RougeLAActive
DSH190064BRChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S NEPHROLOGY - Pediatric Nephrology8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BSChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S PULMONARY - Pediatric Pulmonary8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BTChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S ORTHOPEDIC - Pediatric Orthopedic8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BUChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S ADOLESCENT MEDICINE - Pediatric Adolescent Medicine8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BVChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S ALLERGY&IMMUNOLOGY - Pediatric Allergy & Immunology8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BWChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S NEUROSURGERY - Pediatric Neurosurgery8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BXChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S INFECTIOUS DISEASE - Pediatric Infectious Disease8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BYChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S ENDOCRINOLOGY - Pediatric Endocrinology8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064BZChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S GASTROENTEROLOGY - Pediatric Gastroenterology8200 Constantin BlvdBaton RougeLAActive
DSH190064CChildDSHOUR LADY OF THE LAKEEarly Interven HIV Mid City Clinic1401 N Foster DriveBaton RougeLAActive
DSH190064CAChildDSHOUR LADY OF THE LAKELSU North Baton Rouge Imaging - Imaging Services5439 Airline HwyBaton RougeLAActive
DSH190064CBChildDSHOUR LADY OF THE LAKEOLOL Livingston Imaging - Imaging Services5000 O'Donovan BlvdWalkerLAActive
DSH190064CCChildDSHOUR LADY OF THE LAKEOLOL Livingston Cardiac Imaging - Imaging Services5000 O'Donovan BlvdWalkerLAActive
DSH190064CDChildDSHOUR LADY OF THE LAKELSU Health Baton Rouge MidCity Clinic Imaging Services1401 N Foster DriveBaton RougeLAActive
DSH190064CEChildDSHOUR LADY OF THE LAKEOLOL Ascension Heart Vascular Ctr - Cath Lab1125 W Highway 30GonzalesLAActive
DSH190064CFChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S ENT - Ear, Nose, and Throat8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064CGChildDSHOUR LADY OF THE LAKEOur Lady of the Lake Advanced Diagnostics - Imaging7777 Hennessy BlvdBaton RougeLAActive
DSH190064CHChildDSHOUR LADY OF THE LAKEOLOL CHILDREN'S NEUROLOGY - Pediatric Neurology8200 CONSTANTIN BLVDBATON ROUGELAActive
DSH190064CJChildDSHOUR LADY OF THE LAKESt Elizabeth Infusion2647 St Elizabeth BlvdGonzalesLAActive
DSH190064CKChildDSHOUR LADY OF THE LAKELake Main Campus-OP Diabetes Management - Diabetes2041 Silverside DrBaton RougeLAApproved
DSH190064CLChildDSHOUR LADY OF THE LAKELake Childrens Hospital-Respiratory - Respiratory8300 Constantin BlvdBaton RougeLAApproved
DSH190064CMChildDSHOUR LADY OF THE LAKELSU Mid City Location-Diabetes and Nutrition - Nutrition1401 N Foster DrBaton RougeLAApproved
DSH190064DChildDSHOUR LADY OF THE LAKEDiab Ft & Wound Mid City Clinic1401 N Foster DriveBaton RougeLAActive
DSH190064EChildDSHOUR LADY OF THE LAKEDermatology Mid City Clinic1401 N Foster DriveBaton RougeLAActive
DSH190064FChildDSHOUR LADY OF THE LAKELSU Perkins-Adult Ophthalmology9032 Perkins RoadBaton RougeLAActive
DSH190064GChildDSHOUR LADY OF THE LAKELSU North-Oral Surgery Clinic9032 Perkins RoadBaton RougeLAActive
DSH190064HChildDSHOUR LADY OF THE LAKELSU Perkins-Adult Orthopedic Surgery9032 Perkins RoadBaton RougeLAActive
DSH190064JChildDSHOUR LADY OF THE LAKEInfusion North BR Clinic5439 Airline HwyBaton RougeLAActive
DSH190064KChildDSHOUR LADY OF THE LAKEOncology North BR Clinic5439 Airline HwyBaton RougeLAActive
DSH190064LChildDSHOUR LADY OF THE LAKENorth BR Clinic Primary Care5439 Airline HwyBaton RougeLAActive
DSH190064MChildDSHOUR LADY OF THE LAKELSU North-Urgent Care Clinic5439 Airline HwyBaton RougeLAActive
DSH190064NChildDSHOUR LADY OF THE LAKELSU Perkins-Endoscopy9032 Perkins RoadBaton RougeLAActive
DSH190064PChildDSHOUR LADY OF THE LAKELSU Perkins-Operating Room9032 Perkins RoadBaton RougeLAActive
DSH190064QChildDSHOUR LADY OF THE LAKELSU Perkins-PACU9032 Perkins RoadBaton RougeLAActive
DSH190064RChildDSHOUR LADY OF THE LAKEMedicine OLOL MOB IV Clinic5131 O'Donovan DriveBaton RougeLAActive
DSH190064SChildDSHOUR LADY OF THE LAKEMedicine Subspecialty OLOL MOB IV Clinic5131 O'Donovan DriveBaton RougeLAActive
DSH190064TChildDSHOUR LADY OF THE LAKE HOSPITAL, INC.South BR Clinic950 E WashingtonBaton RougeLATerminated
DSH190064UChildDSHOUR LADY OF THE LAKE REGIONAL MED CTRLSU Perkins-Pre Admit9032 Perkins RoadBaton RougeLATerminated
DSH190064VChildDSHOUR LADY OF THE LAKELouisiana Cardiology Associates Imaging7777 Hennessy BlvdBaton RougeLAActive
DSH190064WChildDSHOUR LADY OF THE LAKE HOSPITAL, INC.Our Lady of the Lake Outpatient Infusion at Picardy8119 Picardy AvenueBaton RougeLATerminated
DSH190064XChildDSHOUR LADY OF THE LAKESt. Jude Baton Rouge Affiliate Clinic8300 Constantin BlvdBaton RougeLAActive
DSH190064YChildDSHOUR LADY OF THE LAKELake Main Campus-Infusion7777 Hennessy BlvdBaton RougeLAActive
DSH190064ZChildDSHOUR LADY OF THE LAKE HOSPITAL, INC.Franciscan Clinic7777 Hennessy BlvdBaton RougeLATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertGroup Change Request Our Lady of the Lake St Elizabeth 1125 W Highway 30 Gonzales, LA 70737-50044/4/2025 9:14 AM
DetailsLast Recertification DateUpdateRecertification9/2/2023 12:02:48 PM8/15/2024 2:34:53 PM8/15/2024 2:34 PM
DetailsEntity NameUpdateChange RequestOUR LADY OF THE LAKE REGIONAL MED CTROUR LADY OF THE LAKE2/5/2024 7:57 AM
ContactsPrimary ContactUpdateProfile Change RequestGreene, Thomas Director of Integrated Pharmacy Operations OUR LADY OF THE LAKE REGIONAL MED CTR 2257658786Greene, Thomas Senior Director of Pharmacy, Baton Rouge Market OUR LADY OF THE LAKE REGIONAL MED CTR 225765878610/12/2023 3:42 PM
DetailsEntity NameUpdateChange RequestOUR LADY OF THE LAKE HOSPITAL, INC.OUR LADY OF THE LAKE REGIONAL MED CTR9/11/2023 1:37 PM
ContactsPrimary ContactUpdatePC Change RequestMellor, Britney Ross Senior Director of Pharmacy Our Lady of the Lake Regional Medical Center 2257653067Greene, Thomas Director of Integrated Pharmacy Operations OUR LADY OF THE LAKE REGIONAL MED CTR 22576587869/5/2023 7:16 AM
DetailsLast Recertification DateUpdateRecertification8/25/2022 1:17:16 PM9/2/2023 12:02:48 PM9/2/2023 12:02 PM
DetailsLast Recertification DateUpdateRecertification8/25/2021 12:41:18 PM8/25/2022 1:17:16 PM8/25/2022 1:17 PM
ContactsAuthorizing OfficialUpdateChange RequestStanton, Lowell Edward Chief Financial Officer Our Lady of the Lake Regional Medical Center 2257658550Clowers, Jennifer Chief Financial Officer FMOLHS 22576585508/11/2022 3:55 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1938589 (LA) 12/15/2021 4:10 PM
AddressesBilling AddressUpdateGroup Change RequestOur Lady of the Lake REG MED CTR ATTN PHARMACY PO Box 83880 Baton Rouge, LA 70884-3880FMOLHS Accounts Payable P.O. Box 83880 Baton Rouge, LA 7088412/8/2021 9:36 AM
DetailsLast Recertification DateUpdateRecertification9/13/2020 5:18:11 PM8/25/2021 12:41:18 PM8/25/2021 12:41 PM
AddressesBilling AddressInsertChange Request Our Lady of the Lake REG MED CTR ATTN PHARMACY PO Box 83880 Baton Rouge, LA 70884-38807/7/2021 8:55 AM
ContactsPrimary ContactUpdateChange RequestMohundro, Michael Marlan Senior Director of Pharmacy Our Lady of the Lake RMC 2259077045Mellor, Britney Ross Senior Director of Pharmacy Our Lady of the Lake Regional Medical Center 22576530675/25/2021 12:12 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (AL) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (CA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (DE) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (ID) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (ME) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (MI) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (MN) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (MO) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (NV) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (VA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1366436123 (WI) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1005587 (AK) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request127947105 (AR) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request68957 (AZ) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request95015574 (CO) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request8087863 (CT) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request8050061 (CT) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request46047631 (DC) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request96632100 (FL) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request000393181X (GA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request579664 (IA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request720423651001 (IL) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300018975 (IN) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request200270200A (KS) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1370287 (KY) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request110128871B (MA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request110128871A (MA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request616017400 (MD) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request20433 (MS) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request427737 (MT) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1900064 (NC) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request10026685900 (NE) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request666823 (NJ) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request51051737 (NM) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1461150 (NY) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request440437 (OH) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request200036510A (OK) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request500613214 (OR) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1019706740001 (PA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request10738B (SC) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request190064 (TN) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request107816401 (TX) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1010764 (UT) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request6703509 (VT) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request2037942 (WA) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: NumberDeleteChange Request3810009186 (WV) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (AL) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (CA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (DE) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (ID) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (ME) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MI) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MN) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MO) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NV) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (VA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (WI) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (AK) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (AR) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (AZ) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (CO) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (CT) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (DC) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (FL) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (GA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (IA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (IL) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (IN) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (KS) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (KY) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MD) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MS) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (MT) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NC) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NE) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NJ) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NM) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (NY) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (OH) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (OK) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (OR) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (PA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (SC) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (TN) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (TX) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (UT) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (VT) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (WA) 3/21/2021 3:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1366436123 (WV) 3/21/2021 3:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19385899/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 22070419/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification AL9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification CA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification DE9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification ID9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification ME9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MI9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MN9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MO9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NV9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification VA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10055879/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification AK9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1279471059/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification AR9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 689579/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification AZ9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 950155749/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification CO9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 80878639/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification CT9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 80500619/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification CT9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 460476319/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification DC9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 966321009/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification FL9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 000393181X9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification GA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 5796649/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification IA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 7204236510019/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification IL9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3000189759/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification IN9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 200270200A9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification KS9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 13702879/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification KY9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 110128871B9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 110128871A9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 6160174009/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MD9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 204339/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MS9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 4277379/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification MT9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19000649/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NC9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 100266859009/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NE9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 6668239/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NJ9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 510517379/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NM9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 14611509/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification NY9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 4404379/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification OH9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 200036510A9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification OK9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 5006132149/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification OR9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10197067400019/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification PA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10738B9/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification SC9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1900649/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification TN9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1078164019/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification TX9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10107649/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification UT9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 67035099/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification VT9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 20379429/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification WA9/13/2020 5:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/13/2020 5:18 PM
Medicaid BillingMedicaid: NumberInsertRecertification 38100091869/13/2020 5:18 PM
Medicaid BillingMedicaid: StateInsertRecertification WV9/13/2020 5:18 PM
Medicaid BillingNPI: NumberDeleteRecertification1366436123 ( ) 9/13/2020 5:18 PM
Medicaid BillingNPI: NumberDeleteRecertification1215365341 ( ) 9/13/2020 5:18 PM
Medicaid BillingNPI: NumberDeleteRecertification1831605062 ( ) 9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 17408477719/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 18316050629/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 12153653419/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification LA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification AL9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification CA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification DE9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification ID9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification ME9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MI9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MN9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MO9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NV9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification VA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification WI9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification AK9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification AR9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification CO9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification CT9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification DC9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification FL9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification GA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification IA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification IL9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification IN9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification KS9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification KY9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MD9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MS9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification MT9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NC9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NE9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NM9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification NY9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification OH9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification OK9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification OR9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification PA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification SC9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification TN9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification TX9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification UT9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification VT9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification WA9/13/2020 5:18 PM
Medicaid BillingNPI: NumberInsertRecertification 13664361239/13/2020 5:18 PM
Medicaid BillingNPI: StateInsertRecertification WV9/13/2020 5:18 PM
DetailsLast Recertification DateUpdateRecertification9/16/2019 4:54:40 PM9/13/2020 5:18:11 PM9/13/2020 5:18 PM
ContactsAuthorizing OfficialUpdateAO Change RequestLimbocker, Jeffrey CFO Our Lady of the Lake 2257658550-2259077045Stanton, Lowell Edward Chief Financial Officer Our Lady of the Lake Regional Medical Center 22576585504/22/2020 1:40 PM
DetailsLast Recertification DateUpdateRecertification 9/16/2019 4:54:40 PM9/16/2019 4:54 PM
ContactsAuthorizing OfficialUpdateNew RegistrationLimbocker, Jeffrey CFO Our Lady of the Lake 2257658550Limbocker, Jeffrey CFO Our Lady of the Lake 2257658550-22590770457/15/2019 5:01 PM
ContactsSigned ByUpdateNew RegistrationLimbocker, Jeffrey CFO Our Lady of the Lake 2257658550Limbocker, Jeffrey CFO Our Lady of the Lake 2257658550-22590770457/15/2019 5:01 PM
DetailsStateUpdate ApprovedActive7/1/2019 12:05 AM
ContactsSigned ByInsertNew Registration Limbocker, Jeffrey CFO Our Lady of the Lake 22576585505/24/2019 9:51 AM
Details340B IDUpdateNew Registration DSH190064AW5/24/2019 9:51 AM
DetailsEntity SubnameUpdateNew RegistrationOLOL STE - SLEEP LABOLOL STE - SLEEP LAB - SLEEP LAB5/24/2019 9:51 AM
DatesParticipating Approval DateUpdateNew Registration 5/24/2019 9:51:15 AM5/24/2019 9:51 AM
DetailsStateUpdateNew RegistrationPendingApproved5/24/2019 9:51 AM
DatesSigned By DateUpdateNew Registration 4/12/2019 4:36:19 PM5/24/2019 9:51 AM
DatesStart DateUpdateNew Registration 7/1/2019 12:00:00 AM5/24/2019 9:51 AM
AddressesMain AddressInsertNew Registration  1125 W Highway 30 Gonzales, LA 70737-50044/12/2019 4:36 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/12/2019 4:36 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 17201604/12/2019 4:36 PM
Medicaid BillingMedicaid: StateInsertNew Registration LA4/12/2019 4:36 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/12/2019 4:36 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 22023754/12/2019 4:36 PM
Medicaid BillingMedicaid: StateInsertNew Registration LA4/12/2019 4:36 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/12/2019 4:36 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 22056414/12/2019 4:36 PM
Medicaid BillingMedicaid: StateInsertNew Registration LA4/12/2019 4:36 PM
Medicaid BillingNPI: NumberInsertNew Registration 13664361234/12/2019 4:36 PM
Medicaid BillingNPI: NumberInsertNew Registration 12153653414/12/2019 4:36 PM
Medicaid BillingNPI: NumberInsertNew Registration 18316050624/12/2019 4:36 PM
ContactsPrimary ContactInsertNew Registration Mohundro, Michael Marlan Senior Director of Pharmacy Our Lady of the Lake RMC 22590770454/12/2019 4:36 PM
ContactsAuthorizing OfficialInsertNew Registration Limbocker, Jeffrey CFO Our Lady of the Lake 22576585504/12/2019 4:36 PM
DetailsLast Recertification DateInsertNew Registration  4/12/2019 4:36 PM
DetailsGrant NumberInsertNew Registration  4/12/2019 4:36 PM
Details340B IDInsertNew Registration  4/12/2019 4:36 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/12/2019 4:36 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/12/2019 4:36 PM
DetailsMedicare Provider NumberInsertNew Registration 1900644/12/2019 4:36 PM
DetailsEntity NameInsertNew Registration OUR LADY OF THE LAKE HOSPITAL, INC.4/12/2019 4:36 PM
DetailsProgram CodeInsertNew Registration DSH4/12/2019 4:36 PM
DetailsEntity SubnameInsertNew Registration OLOL STE - SLEEP LAB4/12/2019 4:36 PM
DatesParticipating Approval DateInsertNew Registration  4/12/2019 4:36 PM
DetailsStateInsertNew Registration Pending4/12/2019 4:36 PM
DatesRegistration DateInsertNew Registration 4/12/2019 4:36:17 PM4/12/2019 4:36 PM
DatesSigned By DateInsertNew Registration  4/12/2019 4:36 PM
DatesStart DateInsertNew Registration  4/12/2019 4:36 PM
TerminationsTermination CommentsInsertNew Registration  4/12/2019 4:36 PM
TerminationsTermination DateInsertNew Registration  4/12/2019 4:36 PM
TerminationsTermination Effective DateInsertNew Registration  4/12/2019 4:36 PM
TerminationsTermination ReasonInsertNew Registration  4/12/2019 4:36 PM