340B Drug Pricing Program Database
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DSH190002H LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Outpatient Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002H
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Lafayette General Medical Center
Al Jude Patin, Chief Executive Officer
(337) 354-9334
Primary Contact
Ochsner Lafayette General
Rodney J Good, AVP Pharmacy
(337) 289-7888
Addresses
Street Address
1211 Coolidge Street
Second floor
Lafayette, LA 70503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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