Covered Entity Details

DSH190065Q BATON ROUGE GENERAL MEDICAL CENTER (Active) - information as of 6/26/2025 3:08:02 AM

Main Details

Name

BATON ROUGE GENERAL MEDICAL CENTER

Subdivision Name

Baton Rouge General Medical Center Radiology - Radiology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190065Q

Medicare Provider Number

190065

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/28/2020

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

Baton Rouge General Medical Center
Kendall Johnson, CFO
(225) 237-1645

Primary Contact

Baton Rouge General Health System
Raneesha Ford, Director, Pharmacy Services
(225) 763-4087

Addresses

Street Address

8585 Picardy Ave
Baton Rouge, LA 70809

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	1720020	1962537407

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
DSH190065A	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Bluebonnet	8585 PICARDY AVE	BATON ROUGE	LA	Terminated
DSH190065AA	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - ASCENSION - Respiratory Therapy	14105 HIGHWAY 73	PRAIRIEVILLE	LA	Active
DSH190065AB	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - ASCENSION - Radiology	14105 HIGHWAY 73	PRAIRIEVILLE	LA	Active
DSH190065B	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BEHAVIORAL WELLNESS CENTER	4540 NORTH BLVD	BATON ROUGE	LA	Active
DSH190065C	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BEHAVIORAL WELLNESS CENTER	4739 LOUISIANA HWY 10	JACKSON	LA	Terminated
DSH190065D	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Endoscopy Center-Perkins	6615 PERKINS RD	BATON ROUGE	LA	Active
DSH190065E	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	PENNINGTON CANCER CENTER OUTPATIENT	8585 PICARDY AVE	BATON ROUGE	LA	Active
DSH190065F	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	PENNINGTON CANCER CTR OP INFUSION	8585 PICARDY AVE	BATON ROUGE	LA	Active
DSH190065G	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	OUTPATIENT THER	8585 PICARDY AVE SUITE 516	BATON ROUGE	LA	Active
DSH190065H	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	IMAGING CENTER	5422 DIJON DRIVE	BATON ROUGE	LA	Active
DSH190065J	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	IMAGING CENTER	2550 ONEAL LN	BATON ROUGE	LA	Active
DSH190065K	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	ADVANCE WOUND CENTER	8595 Picardy Ave	BATON ROUGE	LA	Active
DSH190065L	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Sleep Disorder Clinic - Sleep Disorder	8595 Picardy Ave	Baton Rouge	LA	Active
DSH190065M	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - CENTER FOR HEALTH - OUTPATIENT THERAPY	9001 SUMMA AVE	BATON ROUGE	LA	Active
DSH190065N	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Baton Rouge General Medical Center Operating Room - Surgery	8585 Picardy Ave	Baton Rouge	LA	Active
DSH190065P	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Baton Rouge General Medical Center Emergency - Emergency Department	8585 Picardy Ave	Baton Rouge	LA	Active
DSH190065Q	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	Baton Rouge General Medical Center Radiology - Radiology	8585 Picardy Ave	Baton Rouge	LA	Active
DSH190065R	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	MidCity - Pennington Cancer Center	3600 Florida Boulevard	Baton Rouge	LA	Active
DSH190065S	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	MidCity - Physical Medicine	3600 Florida Boulevard	Baton Rouge	LA	Active
DSH190065T	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	MidCity - Hyperbarics & Wound Treatment Center	3600 Florida Boulevard	Baton Rouge	LA	Active
DSH190065U	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	MidCIty - Sleep Disorder Clinic	3600 Florida Boulevard	Baton Rouge	LA	Active
DSH190065V	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	MidCity - Radiology Imaging Services	3600 Florida Boulevard	Baton Rouge	LA	Active
DSH190065W	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	CCL - BB - Comprehensive Care Clinic	8585 Picardy Avenue	Baton Rouge	LA	Active
DSH190065X	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - ASCENSION - Comprehensive Care Center Ascension	14105 HIGHWAY 73	PRAIRIEVILLE	LA	Active
DSH190065Y	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - ASCENSION - Physical Therapy	14105 HIGHWAY 73	PRAIRIEVILLE	LA	Active
DSH190065Z	Child	DSH	BATON ROUGE GENERAL MEDICAL CENTER	BATON ROUGE GENERAL - ASCENSION - Emergency Room	14105 HIGHWAY 73	PRAIRIEVILLE	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Johnson, Kendall CFO Baton Rouge General Medical Center 2252371645	Johnson, Kendall CFO Baton Rouge General Medical Center 2252371645	4/10/2025 12:15 PM
Details	Last Recertification Date	Update	Recertification	8/31/2023 9:10:11 AM	9/6/2024 4:20:01 PM	9/6/2024 4:20 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 11:11:17 AM	8/31/2023 9:10:11 AM	8/31/2023 9:10 AM
Contacts	Primary Contact	Update	Recertification	Ford, Raneesha Director, Pharmacy Services Baton Rouge General Medical Center 2257634087	Ford, Raneesha Director, Pharmacy Services Baton Rouge General Health System 2257634087	9/7/2022 11:11 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 1:02:26 PM	9/7/2022 11:11:17 AM	9/7/2022 11:11 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 11:38:41 AM	8/17/2021 1:02:26 PM	8/17/2021 1:02 PM
Contacts	Primary Contact	Update	Change Request	Mumford, Stephen Vice President Clinical Service Lines Baton Rouge General Medical Center 2257634771	Ford, Raneesha Director, Pharmacy Services Baton Rouge General Medical Center 2257634087	5/27/2021 6:27 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	8/28/2020 11:38 AM
Details	Last Recertification Date	Update	Recertification		8/28/2020 11:38:41 AM	8/28/2020 11:38 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Johnson, Kendall CFO Baton Rouge General Medical Center 2252371645	4/28/2020 11:06 AM
Details	340B ID	Update	New Registration		DSH190065Q	4/28/2020 11:06 AM
Details	Entity Name	Update	New Registration	BATON ROUGE GENERAL	BATON ROUGE GENERAL MEDICAL CENTER	4/28/2020 11:06 AM
Details	Entity Subname	Update	New Registration	Baton Rouge General Medical Center Radiology	Baton Rouge General Medical Center Radiology - Radiology	4/28/2020 11:06 AM
Dates	Participating Approval Date	Update	New Registration		4/28/2020 11:06:10 AM	4/28/2020 11:06 AM
Details	State	Update	New Registration	Pending	Approved	4/28/2020 11:06 AM
Dates	Signed By Date	Update	New Registration		4/27/2020 2:58:18 PM	4/28/2020 11:06 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/28/2020 11:06 AM
Addresses	Main Address	Insert	New Registration		8585 Picardy Ave Baton Rouge, LA 70809	4/14/2020 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2020 11:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1720020	4/14/2020 11:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/14/2020 11:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1962537407	4/14/2020 11:48 AM
Contacts	Authorizing Official	Insert	New Registration		Johnson, Kendall CFO Baton Rouge General Medical Center 2252371645	4/14/2020 11:48 AM
Contacts	Primary Contact	Insert	New Registration		Mumford, Stephen Vice President Clinical Service Lines Baton Rouge General Medical Center 2257634771	4/14/2020 11:48 AM
Details	Last Recertification Date	Insert	New Registration			4/14/2020 11:48 AM
Details	Grant Number	Insert	New Registration			4/14/2020 11:48 AM
Details	340B ID	Insert	New Registration			4/14/2020 11:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2020 11:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2020 11:48 AM
Details	Medicare Provider Number	Insert	New Registration		190065	4/14/2020 11:48 AM
Details	Entity Name	Insert	New Registration		BATON ROUGE GENERAL	4/14/2020 11:48 AM
Details	Program Code	Insert	New Registration		DSH	4/14/2020 11:48 AM
Details	Entity Subname	Insert	New Registration		Baton Rouge General Medical Center Radiology	4/14/2020 11:48 AM
Dates	Participating Approval Date	Insert	New Registration			4/14/2020 11:48 AM
Details	State	Insert	New Registration		Pending	4/14/2020 11:48 AM
Dates	Registration Date	Insert	New Registration		4/14/2020 11:48:52 AM	4/14/2020 11:48 AM
Dates	Signed By Date	Insert	New Registration			4/14/2020 11:48 AM
Dates	Start Date	Insert	New Registration			4/14/2020 11:48 AM
Terminations	Termination Comments	Insert	New Registration			4/14/2020 11:48 AM
Terminations	Termination Date	Insert	New Registration			4/14/2020 11:48 AM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2020 11:48 AM
Terminations	Termination Reason	Insert	New Registration			4/14/2020 11:48 AM