340B Drug Pricing Program Database
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DSH190002AY LAFAYETTE GENERAL MEDICAL CENTER (ToBeTerminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Speech Therapy LGOH AC02 - LGOH SPEECH THERAPY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002AY
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/21/2023
Last Recertification Date
8/30/2024
Termination Date
Termination Reason
7/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Lafayette General Medical Center
Al Jude Patin, Chief Executive Officer
(337) 354-9334
Primary Contact
OLG Lafayette General Medical Center
Caleb Stephenson, Director - Pharmacy
(337) 289-7853
Addresses
Street Address
2810 Ambassador Caffery Parkway
Lafayette, LA 70506
Billing Address
Ochsner Clinic Foundation - Accounts Payable
1201 Dickory Ave
New Orleans, LA 70123
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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