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DSH190039M WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER (Active)
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Main Details
Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
WEST JEFFERSON FAMILY DOCTORS - POB S850 FAMILY MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190039M
Medicare Provider Number
190039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/27/2018
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
West Jefferson Medical Center
Chad Miller, CFO
(504) 349-6021
Primary Contact
West Jefferson Medical Center
Cheryl L JacksonBrown, Phamacy Director
(504) 349-1700
Addresses
Street Address
1111 MEDICAL CENTER BLVD
S850
MARRERO, LA 70072
Billing Address
WEST JEFFERSON MEDICAL CENTER
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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