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DSH190005B University Medical Center Managment Corporation d/b/a Interim LSU Hospital (Terminated)
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Main Details
Name
University Medical Center Managment Corporation d/b/a Interim LSU Hospital
Subdivision Name
MCLNO HIV Outpatient Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190005B
Medicare Provider Number
190005
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2007
Participating Start Date
10/1/2007
Participating Approval Date
8/9/2007
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
UMCNO
Lisa Miranda, Chief Operating Officer
(504) 702-4411
Primary Contact
Anthony Laurent, Pharmacy Director
(504) 903-3022
Addresses
Street Address
2235 Poydras Street
NEW ORLEANS, LA 70119
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/27/12 update sub entitiy name from MCLNO South Roman Clinic and update address from 136 S ROMAN NEW ORLEANS, LA 70112 PARTICIPATED AS DSH1426C FROM 4/97-10/06, NOT ELIGIBLE 10/1/06 - 03/31/07, REINSTATED 4/1/07 TO 6/30/07, NOT ELIGIBLE 7/1/07 TO 9/30/07
02/27/2012
PARTICIPATED AS DSH1426C FROM 4/97-10/06, NOT ELIGIBLE 10/1/06 - 03/31/07, REINSTATED 4/1/07 TO 6/30/07, NOT ELIGIBLE 7/1/07 TO 9/30/07
01/11/2007
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