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DSH190039R WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER (Terminated)
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Main Details
Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
WEST JEFFERSON MEDICAL CENTER-FAMIL - Family Doctors- Luling
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190039R
Medicare Provider Number
190039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/20/2021
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
West Jefferson Medical Center
Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105
Primary Contact
West Jefferson Medical Center
Leigh-Ann S. Williams, 340B Analyst
(504) 349-1700 Ext: 6932
Addresses
Street Address
107 MARYLAND DRIVE
LULING, LA 70070-2163
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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