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RRC190027-00 ST. PATRICK HOSPITAL (Terminated)
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Main Details
Name
ST. PATRICK HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC190027-00
Medicare Provider Number
190027
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2022
Participating Start Date
1/10/2022
Participating Approval Date
1/6/2022
Last Recertification Date
9/11/2023
Termination Date
Termination Reason
1/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
CHRISTUS Hospital
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Primary Contact
CHRISTUS St. Patrick Hospital
Shanna M. Thibodeaux, Director of Pharmacy
(337) 491-7747
Addresses
Street Address
524 DR. MICHAEL DEBAKEY DRIVE
LAKE CHARLES, LA 70601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2018, Termination Date 10/1/2019. Reinstatement 1/10/2022
01/10/2022
April 2025
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