340B Drug Pricing Program Database
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DSH190002Z LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
LGO ICU
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002Z
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/31/2017
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
7/1/2022
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 Ambasador Caffery Pkwy
Lafayette, LA 70506
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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