340B Drug Pricing Program Database
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DSH190060K Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital (ToBeTerminated)
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Main Details
Name
Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital
Subdivision Name
W.O. Moss Memorial Health Clinic- Radiology/Diagnostics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190060K
Medicare Provider Number
190060
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
6/21/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/27/2013
Last Recertification Date
8/16/2024
Termination Date
Termination Reason
7/1/2025
Business decision by the Covered Entity
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
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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