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DSH190102J OUR LADY OF LOURDES RMC (Terminated)
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Main Details
Name
OUR LADY OF LOURDES RMC
Subdivision Name
WCH OCCUPATIONAL THERAPY - WCH OCCUPATIONAL THERAPY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190102J
Medicare Provider Number
190102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/10/2020
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Our Lady of the Lourdes Medical Center
Lowell Edward Stanton, 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
4600 AMBASSADOR CAFFERY PKWY
LAFAYETTE, LA 70508
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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