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OCHSNER SPECIALTY PHARMACY
DSH190002 LAFAYETTE GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190002
Entity Address
1214 COOLIDGE STREET
LAFAYETTE, LA 70503
Medicare Provider Number
190002
Participating Start Date
10/25/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OCHSNER SPECIALTY PHARMACY
Pharmacy Address
1405 JEFFERSON HWY
SUITE A
NEW ORLEANS, LA 70121
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
al jude patin, SVP, Chief Operating Officer
(337) 289-7743
Contract Pharmacy Representative
Ochsner Pharmacy
Richard Ricky Indovina Jr., Director of Reatail Pharmacy Operations
(504) 842-5623
Signed By Date
10/15/2020
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