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DSH190039F WEST JEFFERSON MEDICAL CENTER (Terminated)
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Main Details
Name
WEST JEFFERSON MEDICAL CENTER
Subdivision Name
INTERNAL MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190039F
Medicare Provider Number
190039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
Termination Date
Termination Reason
10/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
West Jefferson Medical Center
Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105
Primary Contact
West Jefferson Medical Center
Nancy Cassagne, Chief Executive Officer
(504) 349-1100
Addresses
Street Address
1111 MEDICAL CENTER BLVD.
SUITE S850
MARRERO, LA 70072
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/24/17 previously participating 4/1/10 until terminated 7/1/15, reinstated effective 4/1/17
02/24/2017
April 2025
April 2025
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