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OCHSNER AMERICAN LEGION HOSPITAL RETAIL
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 AMERICAN LEGION HOSPITAL RETAIL
Pharmacy Address
1634 ELTON RD FL 1
JENNINGS, LA 70546
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Al Jude Patin, Chief Executive Officer
(337) 354-9334
Contract Pharmacy Representative
Ochsner Lafayette General
Logan Kelley, Manager of Retail Pharmacy
(337) 266-4869
Signed By Date
4/9/2025
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