340B Drug Pricing Program Database
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DSH190002M LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
LGSW Cath Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002M
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
11/7/2017
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Lafayette General Medical Center
al jude patin, SVP, Chief Operating Officer
(337) 289-7743
Primary Contact
Lafayette General Hospital
Philip Bruno, Director of Pharmacy
(337) 289-7888
Addresses
Street Address
2810 Ambassador Caffery Pkwy
Lafayette, LA 70506
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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