340B Drug Pricing Program Database
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DSH190020G LANE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
LANE REGIONAL MEDICAL CENTER
Subdivision Name
Lane Family Practice
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190020G
Medicare Provider Number
190020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Lane Regional Medical Center
Frank Corcoran, CEO
(225) 658-4303
Primary Contact
Lane Regional Medical Center
Jassoni Shae Martin, Director of Pharmacy
(225) 658-4364
Addresses
Street Address
2335 CHURCH ST STE E
Lane FAMILY PRACTICE
ZACHARY, LA 70791-2700
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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