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FRANCISCAN MISSIONARIES OF OUR LADY HEAL
DSH190064 OUR LADY OF THE LAKE
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Covered Entity Details
Entity Name
OUR LADY OF THE LAKE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190064
Entity Address
REGIONAL MED CTR
5000 HENNESSY BLVD
BATON ROUGE, LA 70808-4375
Medicare Provider Number
190064
Participating Start Date
4/1/2008
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN MISSIONARIES OF OUR LADY HEAL
Pharmacy Address
RXONE ST FRANCIS
309 JACKSON ST
FLOOR 1
MONROE, LA 71201-7407
Pharmacy Comments
Contract Details
Approval Date
7/22/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lowell Edward Stanton, Chief Financial Officer
(337) 470-2147
Contract Pharmacy Representative
FMOLHS
Adria Kerr, Corporate Director of Retail
(225) 765-9014
Signed By Date
7/22/2020
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