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DSH190060F Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital (Active)
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Main Details
Name
Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital
Subdivision Name
Moss Outpatient Specialty Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190060F
Medicare Provider Number
190060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/19/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/19/2013
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Lake Charles Memorial Hospital
Devon Hyde, President/CEO
(337) 494-3200
Primary Contact
Lake Charles Memorial Hospital
Julia Manuel, Health-System Director of Pharmacy
(337) 494-3182
Addresses
Street Address
1000 Walters Street
Lake Charles, LA 70607
Billing Address
Lake Charles Memorial Hospital
1701 Oak Park Blvd
Lake Charles, LA 70601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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