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DSH190039X WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER (Active)
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Main Details
Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
WEST JEFFERSON MEDICAL CENTER N504 - Pulmonology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190039X
Medicare Provider Number
190039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/6/2025
Participating Start Date
4/1/2025
Participating Approval Date
3/5/2025
Last Recertification Date
Contacts
Authorizing Official
West Jefferson Medical Center
Chad Miller, CFO
(504) 349-6021
Primary Contact
West Jefferson Medical Center
Cheryl L JacksonBrown, Phamacy Director
(504) 349-1700
Addresses
Street Address
1111 MEDICAL CENTER BLVD
STE N504
MARRERO, LA 70072-3155
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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