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DSH190060V Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital (Active)
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Main Details
Name
Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital
Subdivision Name
Rheumatology Clinic - Rheumatology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190060V
Medicare Provider Number
190060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/20/2023
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Lake Charles Memorial Hospital
Devon Hyde, President/CEO
(337) 494-3200
Primary Contact
Lake Charles Memorial Hospital
Julia Manuel, Health-System Director of Pharmacy
(337) 494-3182
Addresses
Street Address
2800 2nd Avenue Suite C
Lake Charles, LA 70601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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