Covered Entity Details

DSH190039R WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER (Terminated) - information as of 5/14/2025 10:59:07 PM

Main Details

Name

WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER

Subdivision Name

WEST JEFFERSON MEDICAL CENTER-FAMIL - Family Doctors- Luling

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190039R

Medicare Provider Number

190039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/20/2021

Last Recertification Date

8/31/2022

Termination Date
Termination Reason

10/1/2022
Site closure

Contacts

Authorizing Official

West Jefferson Medical Center
Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105

Primary Contact

West Jefferson Medical Center
Leigh-Ann S. Williams, 340B Analyst
(504) 349-1700 Ext: 6932

Addresses

Street Address

107 MARYLAND DRIVE
LULING, LA 70070-2163

Billing Address

West Jefferson Medical Center
1101 Medical Center Blvd
Marrero, LA 70072

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	1732788	1265437644

Shipping Addresses

Shipping Address 1

West Jefferson Medical Center
1101 Medical Center Blvd.
Marrero, LA 70072

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
DSH190039B	Child	DSH	WEST JEFFERSON MEDICAL CENTER	LAPALCO FAMILY DOCTORS	3909 LAPALCO BLVD..	HARVEY	LA	Terminated
DSH190039C	Child	DSH	WEST JEFFERSON MEDICAL CENTER	MANHATTAN FAMILY DOCTORS	2845 MANHATTAN BLVD.	HARVEY	LA	Terminated
DSH190039D	Child	DSH	WEST JEFFERSON MEDICAL CENTER	OAKWOOD FAMILY DOCTORS	175 HECTOR AVE.	GRETNA	LA	Terminated
DSH190039F	Child	DSH	WEST JEFFERSON MEDICAL CENTER	INTERNAL MEDICINE	1111 MEDICAL CENTER BLVD.	MARRERO	LA	Terminated
DSH190039G	Child	DSH	WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON EAR NOSE AND THROAT	1111 MEDICAL CENTER BLVD.	MARRERO	LA	Terminated
DSH190039H	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	West Jefferson Oncology Clinic	4513 WESTBANK EXPRESSWAY	MARRERO	LA	Active
DSH190039J	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	HEART CLINIC OF LOUISIANA - CARDIOLOGY	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039K	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER - FAM - OAKWOOD FAMILY MEDICINE	175 HECTOR AVENUE	GRETNA	LA	Active
DSH190039L	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER - FAM - MANHATTAN FAMILY MEDICINE	2845 MANHATTAN BLVD.	HARVEY	LA	Active
DSH190039M	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON FAMILY DOCTORS - POB S850 FAMILY MEDICINE	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039N	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER - FAM - LAPALCO FAMILY MEDICINE	3909 LAPALCO BLVD	HARVEY	LA	Active
DSH190039P	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	West Jefferson Medical Center Infusion Center - Oncology - Infusion Center	4511 Westbank Expressway	Marrero	LA	Active
DSH190039Q	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER FAMIL - Family Doctors- Algiers	3712 MACARTHUR BLVD	NEW ORLEANS	LA	Active
DSH190039R	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER-FAMIL - Family Doctors- Luling	107 MARYLAND DRIVE	LULING	LA	Terminated
DSH190039S	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	West Jefferson Medical Center Women's Health - Women's Health	1111 Medical Center Blvd	Marrero	LA	Active
DSH190039T	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER NEURO - Neurosurgery	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039U	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WJMC Latino Clinic - NOPS - Latino Clinic	1111 Medical Center Blvd.	Marrero	LA	Active
DSH190039V	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER-MATER - Maternal Fetal Monitoring	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039W	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WJMC MULTISPECIALTY CLINIC - S450 - Endocrinology, Infectious Disease	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039X	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER N504 - Pulmonology	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039Y	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WOUND CARE & HYPERBARIC MEDICINE CE - Wound Care	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active
DSH190039Z	Child	DSH	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON MEDICAL CENTER S350 - Cardiology	1111 MEDICAL CENTER BLVD	MARRERO	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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	State	Update		To Be Terminated	Terminated	10/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2022 12:00:00 AM	9/9/2022 10:25 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/9/2022 10:25 AM
Terminations	Termination Date	Update	Termination Request		10/1/2022 12:00:00 AM	9/9/2022 10:25 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2022 12:00:00 AM	9/9/2022 10:25 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	9/9/2022 10:25 AM
Details	Last Recertification Date	Update	Recertification		8/31/2022 9:06:30 AM	8/31/2022 9:06 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Smith, Robert Eli Chief Operating Officer—West Jefferson Medical Center West Jefferson Medical Center 5043491105	10/20/2021 8:45 AM
Details	340B ID	Update	New Registration		DSH190039R	10/20/2021 8:45 AM
Details	Entity Name	Update	New Registration	WEST JEFFERSON MEDICAL CENTER	WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER	10/20/2021 8:45 AM
Details	Entity Subname	Update	New Registration	WEST JEFFERSON MEDICAL CENTER-FAMIL	WEST JEFFERSON MEDICAL CENTER-FAMIL - Family Doctors- Luling	10/20/2021 8:45 AM
Dates	Participating Approval Date	Update	New Registration		10/20/2021 8:45:06 AM	10/20/2021 8:45 AM
Details	State	Update	New Registration	Pending	Approved	10/20/2021 8:45 AM
Dates	Signed By Date	Update	New Registration		10/18/2021 8:50:33 AM	10/20/2021 8:45 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/20/2021 8:45 AM
Addresses	Main Address	Insert	New Registration		107 MARYLAND DRIVE LULING, LA 70070-2163	10/13/2021 11:56 AM
Addresses	Billing Address	Insert	New Registration		West Jefferson Medical Center 1101 Medical Center Blvd Marrero, LA 70072	10/13/2021 11:56 AM
Addresses	Shipping Address	Insert	New Registration		West Jefferson Medical Center 1101 Medical Center Blvd. Marrero, LA 70072	10/13/2021 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2021 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1732788	10/13/2021 11:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	10/13/2021 11:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1265437644	10/13/2021 11:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		LA	10/13/2021 11:56 AM
Contacts	Authorizing Official	Insert	New Registration		Smith, Robert Eli Chief Operating Officer—West Jefferson Medical Center West Jefferson Medical Center 5043491105	10/13/2021 11:56 AM
Contacts	Primary Contact	Insert	New Registration		Williams, Leigh-Ann S. 340B Program Coordinator West Jefferson Medical Center 5043491700-6932	10/13/2021 11:56 AM
Details	Assistance Received From Date	Insert	New Registration			10/13/2021 11:56 AM
Details	Assistance Received To Date	Insert	New Registration			10/13/2021 11:56 AM
Details	Last Recertification Date	Insert	New Registration			10/13/2021 11:56 AM
Details	Grant Number	Insert	New Registration			10/13/2021 11:56 AM
Details	340B ID	Insert	New Registration			10/13/2021 11:56 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2021 11:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2021 11:56 AM
Details	Medicare Provider Number	Insert	New Registration		190039	10/13/2021 11:56 AM
Details	Entity Name	Insert	New Registration		WEST JEFFERSON MEDICAL CENTER	10/13/2021 11:56 AM
Details	NOFO Number	Insert	New Registration			10/13/2021 11:56 AM
Details	Program Code	Insert	New Registration		DSH	10/13/2021 11:56 AM
Details	Entity Subname	Insert	New Registration		WEST JEFFERSON MEDICAL CENTER-FAMIL	10/13/2021 11:56 AM
Dates	Participating Approval Date	Insert	New Registration			10/13/2021 11:56 AM
Details	State	Insert	New Registration		Pending	10/13/2021 11:56 AM
Dates	Registration Date	Insert	New Registration		10/13/2021 11:56:04 AM	10/13/2021 11:56 AM
Dates	Signed By Date	Insert	New Registration			10/13/2021 11:56 AM
Dates	Start Date	Insert	New Registration			10/13/2021 11:56 AM
Terminations	Termination Comments	Insert	New Registration			10/13/2021 11:56 AM
Terminations	Termination Date	Insert	New Registration			10/13/2021 11:56 AM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2021 11:56 AM
Terminations	Termination Reason	Insert	New Registration			10/13/2021 11:56 AM