Covered Entity Details

DSH190017D OPELOUSAS GENERAL HOSPITAL (Active) - information as of 4/27/2025 12:55:30 AM

Main Details

Name

OPELOUSAS GENERAL HOSPITAL

Subdivision Name

Opelousas General Health System, Lab - Laboratory-South

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190017D

Medicare Provider Number

190017

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/13/2020

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

190017
Jim Juneau, CFO
(337) 948-5133

Primary Contact

190017
Trey Turner, Pharmacy Manager
(337) 948-3884

Addresses

Street Address

3983 I-49 South Service Road
Opelousas, LA 70570

Billing Address
Same as Street Address

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	1720151	1447230388

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
DSH190017A	Child	DSH	OPELOUSAS GENERAL HOSPITAL	OPELOUSAS GENERAL HOSPITAL SYSTEM, SOUTH CAMPUS	3983 I-49 SOUTH SERVICE ROAD	OPELOUSAS	LA	Terminated
DSH190017B	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Hospital Cancer Center	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017C	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Infusion Clinic	3983 I-49 South Service Road	OPELOUSAS	LA	Active
DSH190017D	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, Lab - Laboratory-South	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017E	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, ED - Emergency Department	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017F	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Health System, Med Img - Medical Imaging-South Campus	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017G	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Opelousas General Hospital - Opelousas General Health System, Radiation Therapy	3983 I-49 South Service Road	Opelousas	LA	Active
DSH190017H	Child	DSH	OPELOUSAS GENERAL HOSPITAL	Wellsmart Health of Opelousas - RHC - Wellsmart Health of Opelousas - RHC	1200 Hospital Drive	Opelousas	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:41:44 AM	8/27/2024 7:59:11 AM	8/27/2024 7:59 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 7:50:53 AM	8/17/2023 10:41:44 AM	8/17/2023 10:41 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:35:49 PM	8/29/2022 7:50:53 AM	8/29/2022 7:50 AM
Contacts	Primary Contact	Update	Group Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	Turner, Trey Pharmacy Manager 190017 3379483884	8/4/2022 4:43 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 11:21:04 AM	8/17/2021 2:35:49 PM	8/17/2021 2:35 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1447230388 ( )		8/18/2020 11:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1447230388	8/18/2020 11:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/18/2020 11:21 AM
Details	Last Recertification Date	Update	Recertification		8/18/2020 11:21:04 AM	8/18/2020 11:21 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Juneau, Jim CFO 190017 3379485133	2/13/2020 11:54 AM
Details	340B ID	Update	New Registration		DSH190017D	2/13/2020 11:54 AM
Details	Entity Subname	Update	New Registration	Opelousas General Health System, Lab	Opelousas General Health System, Lab - Laboratory-South	2/13/2020 11:54 AM
Dates	Participating Approval Date	Update	New Registration		2/13/2020 11:54:52 AM	2/13/2020 11:54 AM
Details	State	Update	New Registration	Pending	Approved	2/13/2020 11:54 AM
Dates	Signed By Date	Update	New Registration		2/6/2020 9:12:00 AM	2/13/2020 11:54 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/13/2020 11:54 AM
Contacts	Primary Contact	Update	Profile Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379405033	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	1/13/2020 4:20 PM
Contacts	Primary Contact	Update	Profile Change Request	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379405033	1/13/2020 4:19 PM
Addresses	Main Address	Insert	New Registration		3983 I-49 South Service Road Opelousas, LA 70570	1/13/2020 3:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2020 3:24 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1720151	1/13/2020 3:24 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	1/13/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1447230388	1/13/2020 3:24 PM
Contacts	Authorizing Official	Insert	New Registration		Juneau, Jim CFO 190017 3379485133	1/13/2020 3:24 PM
Contacts	Primary Contact	Insert	New Registration		Fusilier, Troy DIRECTOR OF PHARMACY Opelousas General Health System 3379485133	1/13/2020 3:24 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2020 3:24 PM
Details	Grant Number	Insert	New Registration			1/13/2020 3:24 PM
Details	340B ID	Insert	New Registration			1/13/2020 3:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2020 3:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2020 3:24 PM
Details	Medicare Provider Number	Insert	New Registration		190017	1/13/2020 3:24 PM
Details	Entity Name	Insert	New Registration		OPELOUSAS GENERAL HOSPITAL	1/13/2020 3:24 PM
Details	Program Code	Insert	New Registration		DSH	1/13/2020 3:24 PM
Details	Entity Subname	Insert	New Registration		Opelousas General Health System, Lab	1/13/2020 3:24 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2020 3:24 PM
Details	State	Insert	New Registration		Pending	1/13/2020 3:24 PM
Dates	Registration Date	Insert	New Registration		1/13/2020 3:24:40 PM	1/13/2020 3:24 PM
Dates	Signed By Date	Insert	New Registration			1/13/2020 3:24 PM
Dates	Start Date	Insert	New Registration			1/13/2020 3:24 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2020 3:24 PM
Terminations	Termination Date	Insert	New Registration			1/13/2020 3:24 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2020 3:24 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2020 3:24 PM