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DSH190102B OUR LADY OF LOURDES RMC (Active)
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Main Details
Name
OUR LADY OF LOURDES RMC
Subdivision Name
JD MONCUS CANCER CENTER - Outpatient Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190102B
Medicare Provider Number
190102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/15/2019
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Our Lady of Lourdes Health
Jeremy Rogers, VP, Chief Financial Officer
(337) 470-2147
Primary Contact
Our Lady of Lourdes Regional Medical Center
Stacy Boatright, Director of Pharmacy
(337) 470-2111
Addresses
Street Address
4809 AMBASSADOR CAFFERY PKWY
STE 110
LAFAYETTE, LA 70508-8800
Billing Address
FMOLHS Accounts Payable
PO BOX 83880
Baton Rouge, LA 70884-3880
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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