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DSH190102AL OUR LADY OF LOURDES RMC (Active)
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Main Details
Name
OUR LADY OF LOURDES RMC
Subdivision Name
HEART HOSPITAL IMAGING
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190102AL
Medicare Provider Number
190102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/27/2020
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
1105 KALISTE SALOOM RD
LAFAYETTE, LA 70508-5705
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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