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DSH190312 OUR LADY OF THE ANGELS HOSPITAL (Active)
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Main Details
Name
OUR LADY OF THE ANGELS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190312
Medicare Provider Number
190312
Additional Details
Current Program Status
Active
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
FMOLHS
Jennifer Clowers, Chief Financial Officer
(225) 765-8550
Primary Contact
OUR LADY OF THE ANGELS HOSPITAL, INC
LARRY PETERSON, Manager of Pharmacy
(985) 730-6787
Addresses
Street Address
433 Plaza Street
BOGALUSA, LA 70427
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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Provider number (190001) temporarily removed to facilitate re-registration
02/05/2015
April 2025
April 2025
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