340B Drug Pricing Program Database
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DSH190002P LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Nuclear Medicine LGOH AC02 - LGOH NUCLEAR MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002P
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
Last Recertification Date
8/22/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Lafayette General Medical Center
Al Jude Patin, Chief Executive Officer
(337) 354-9334
Primary Contact
Ochsner Lafayette General
Rodney J Good, AVP Pharmacy
(337) 289-7888
Addresses
Street Address
2810 Ambassador Caffery Pkwy
Lafayette, LA 70506
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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