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DSH190004C THIBODAUX REGIONAL HEALTH SYSTEM (Active)
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Main Details
Name
THIBODAUX REGIONAL HEALTH SYSTEM
Subdivision Name
IMAGING & DIAGNOSTIC CENTER OF THIB - MRI - WC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190004C
Medicare Provider Number
190004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/4/2019
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Thibodaux Regional Health System
Stephen H East, Chief Financial Officer
(985) 446-5033 Ext: 4740
Primary Contact
Thibodaux Regional Medical Center
April Benoit Denning, Director of Pharmacy
(985) 493-4545
Addresses
Street Address
726 N ACADIA RD
STE 1500
THIBODAUX, LA 70301-5051
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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