Covered Entity Details

DSH190007J NATCHITOCHES REGIONAL MEDICAL CENTER (Active) - information as of 4/25/2025 6:29:43 PM

Main Details

Name

NATCHITOCHES REGIONAL MEDICAL CENTER

Subdivision Name

NRMC OBGYN ASSOCIATES - Ob/Gyn

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190007J

Medicare Provider Number

190007

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/19/2023

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Natchitoches Regional Medical Center
Damian K. Soileau, CEO
(318) 214-4512

Primary Contact

Natchitoches Regional Medical Center
Kassie Williams, Director of Pharmacy
(318) 214-4359

Addresses

Street Address

627 BIENVILLE CIR
NATCHITOCHES, LA 71457-5744

Billing Address

NATCHITOCHES REGIONAL MEDICAL CENTER
501 KEYSER AVE
NATCHITOCHES, LA 71457

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	1720143,1808067	1689676835,1093933897

Shipping Addresses

Shipping Address 1

NATCHITOCHES REGIONAL MEDICAL CENTER
501 KEYSER AVE
NATCHITOCHES, LA 71457

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
DSH190007A	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NORTH NATCHITOCHES MEDICAL CLINIC - RHC	3194 HIGHWAY 71	CAMPTI	LA	Active
DSH190007B	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MULTI-SPECIALTY CLINIC - GSA	601 KEYSER AVE	NATCHITOCHES	LA	Active
DSH190007C	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC Walk-in Clinic - RHC II	740 E. Keyer Ave.	Natchitoches	LA	Active
DSH190007D	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MULTI-SPECIALTY CLINIC - ENT	601 KEYSER AVE	NATCHITOCHES	LA	Terminated
DSH190007E	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MULTI-SPECIALTY CLINIC - Pulmonology	601 KEYSER AVE	NATCHITOCHES	LA	Active
DSH190007F	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MULTI-SPECIALTY CLINIC - Urology	647 Bienville Circle	NATCHITOCHES	LA	Active
DSH190007G	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MULTI-SPECIALTY CLINIC - Orthopedics	601 KEYSER AVE	NATCHITOCHES	LA	Active
DSH190007H	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NATCHITOCHES PARISH HOSPITAL SERVIC - OP Psych	212 MEDICAL DR	NATCHITOCHES	LA	Active
DSH190007J	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC OBGYN ASSOCIATES - Ob/Gyn	627 BIENVILLE CIR	NATCHITOCHES	LA	Active
DSH190007K	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC CANCER CENTER - Cancer Services	211 MEDICAL DR	NATCHITOCHES	LA	Active
DSH190007L	Child	DSH	NATCHITOCHES REGIONAL MEDICAL CENTER	NRMC MEDICINE ASSOCIATES - Clinic	601 Keyser Ave.	NATCHITOCHES	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 12:57:58 PM	8/19/2024 12:40:41 PM	8/19/2024 12:40 PM
Details	Last Recertification Date	Update	Recertification		8/21/2023 12:57:58 PM	8/21/2023 12:57 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Soileau, Damian K. CEO Natchitoches Regional Medical Center 3182144512	4/19/2023 8:54 AM
Details	340B ID	Update	New Registration		DSH190007J	4/19/2023 8:54 AM
Details	Entity Subname	Update	New Registration	NRMC OBGYN ASSOCIATES	NRMC OBGYN ASSOCIATES - Ob/Gyn	4/19/2023 8:54 AM
Dates	Participating Approval Date	Update	New Registration		4/19/2023 8:54:39 AM	4/19/2023 8:54 AM
Details	State	Update	New Registration	Pending	Approved	4/19/2023 8:54 AM
Dates	Signed By Date	Update	New Registration		4/13/2023 11:16:36 AM	4/19/2023 8:54 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/19/2023 8:54 AM
Addresses	Main Address	Insert	New Registration		627 BIENVILLE CIR NATCHITOCHES, LA 71457-5744	4/13/2023 11:16 AM
Addresses	Billing Address	Insert	New Registration		NATCHITOCHES REGIONAL MEDICAL CENTER 501 KEYSER AVE NATCHITOCHES, LA 71457	4/13/2023 11:16 AM
Addresses	Shipping Address	Insert	New Registration		NATCHITOCHES REGIONAL MEDICAL CENTER 501 KEYSER AVE NATCHITOCHES, LA 71457	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1720143	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1808067	4/13/2023 11:16 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/13/2023 11:16 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1689676835	4/13/2023 11:16 AM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/13/2023 11:16 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1093933897	4/13/2023 11:16 AM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/13/2023 11:16 AM
Contacts	Authorizing Official	Insert	New Registration		Soileau, Damian K. CEO Natchitoches Regional Medical Center 3182144512	4/13/2023 11:16 AM
Contacts	Primary Contact	Insert	New Registration		Williams, Kassie Director of Pharmacy Natchitoches Regional Medical Center 3182144359	4/13/2023 11:16 AM
Details	Assistance Received From Date	Insert	New Registration			4/13/2023 11:16 AM
Details	Assistance Received To Date	Insert	New Registration			4/13/2023 11:16 AM
Details	Last Recertification Date	Insert	New Registration			4/13/2023 11:16 AM
Details	Grant Number	Insert	New Registration			4/13/2023 11:16 AM
Details	340B ID	Insert	New Registration			4/13/2023 11:16 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2023 11:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2023 11:16 AM
Details	Medicare Provider Number	Insert	New Registration		190007	4/13/2023 11:16 AM
Details	Entity Name	Insert	New Registration		NATCHITOCHES REGIONAL MEDICAL CENTER	4/13/2023 11:16 AM
Details	NOFO Number	Insert	New Registration			4/13/2023 11:16 AM
Details	Program Code	Insert	New Registration		DSH	4/13/2023 11:16 AM
Details	Entity Subname	Insert	New Registration		NRMC OBGYN ASSOCIATES	4/13/2023 11:16 AM
Dates	Participating Approval Date	Insert	New Registration			4/13/2023 11:16 AM
Details	State	Insert	New Registration		Pending	4/13/2023 11:16 AM
Dates	Registration Date	Insert	New Registration		4/13/2023 11:16:26 AM	4/13/2023 11:16 AM
Dates	Signed By Date	Insert	New Registration			4/13/2023 11:16 AM
Dates	Start Date	Insert	New Registration			4/13/2023 11:16 AM
Terminations	Termination Comments	Insert	New Registration			4/13/2023 11:16 AM
Terminations	Termination Date	Insert	New Registration			4/13/2023 11:16 AM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2023 11:16 AM
Terminations	Termination Reason	Insert	New Registration			4/13/2023 11:16 AM