340B Drug Pricing Program Database
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CAH191302-01 ST. MARTIN HOSPITAL (Active)
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Main Details
Name
ST. MARTIN HOSPITAL
Subdivision Name
Cancer Ctr Infusion STMH CB08 - STMH INFUSION
Type
Critical Access Hospital
Rural
No
340B ID
CAH191302-01
Medicare Provider Number
191302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ochsner St. Martin Hospital
Jennifer L Vicknair, AVP - Nursing and Hospital Administration
(337) 909-2219
Primary Contact
Ochsner Lafayette General
Rodney J Good, AVP Pharmacy
(337) 289-7888
Addresses
Street Address
225 Champagne Blvd
Breaux Bridge, LA 70517
Billing Address
Ochsner Clinic Foundation - Accounts Payable
1201 Dickory Ave
New Orleans, LA 70123
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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