340B Drug Pricing Program Database
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DSH190064Z OUR LADY OF THE LAKE HOSPITAL, INC. (Terminated)
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Main Details
Name
OUR LADY OF THE LAKE HOSPITAL, INC.
Subdivision Name
Franciscan Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190064Z
Medicare Provider Number
190064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/21/2013
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
FMOLHS
Jennifer Clowers, Chief Financial Officer
(225) 765-8550
Primary Contact
Our Lady of the Lake Regional Medical Center
Britney Ross Mellor, Senior Director of Pharmacy
(225) 765-3067
Addresses
Street Address
7777 Hennessy Blvd
Suite 1009
Baton Rouge, LA 70808
Billing Address
FMOLHS Accounts Payable
P.O. Box 83880
Baton Rouge, LA 70884
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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