Covered Entity Details

RRC180035-43 ST ELIZABETH HEALTHCARE (Active) - information as of 4/29/2025 12:35:40 AM

Main Details

Name

ST ELIZABETH HEALTHCARE

Subdivision Name

St. Elizabeth Edgewood Dearborn Cancer Care Infusion - Cancer Care Infusion

Type

Rural Referral Center

Rural

340B ID

RRC180035-43

Medicare Provider Number

180035

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/27/2025

Last Recertification Date

Contacts

Authorizing Official

St. Elizabeth Healthcare
Lori Ritchey-Baldwin, CFO
(859) 655-1642

Primary Contact

St. Elizabeth Healthcare
Ron Hornberger, Director of Reimbursement
(859) 655-7831

Addresses

Street Address

17525 Greendale Plaza Dr.
Lawrenceburg, IN 47025

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IN	300024657	1467492421
KY	01013671	1467492421
OH	7645114	1467492421

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC180035-01	Child	RRC	ST ELIZABETH HEALTHCARE	Covington MRI - MRI	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-02	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Medical Oncology Ft. Thomas - Medical Oncology	85 North Grand Ave.	Ft. Thomas	KY	Active
RRC180035-03	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Radiation Oncology Ft. Thomas - Radiation Oncology	85 North Grand Ave.	Ft. Thomas	KY	Active
RRC180035-04	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Cancer Care Dearborn - Cancer Care	606 Wilson Creek Rd	Lawrenceburg	IN	Terminated
RRC180035-05	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Infusion Ft. Thomas - Infusion Services	85 North Grand Ave.	Ft. Thomas	KY	Active
RRC180035-06	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Cancer Center Palliative Care Ft. Thomas - Cancer Palliative Care	85 North Grand Ave.	Ft. Thomas	KY	ToBeTerminated
RRC180035-07	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Infusion Center Crestview - Infusion Services	380 Centre View Blvd.	Crestview Hills	KY	Terminated
RRC180035-08	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Women's Wellness 600 Medical - Women's Wellness	600 Medical Village Dr.	Edgewood	KY	Active
RRC180035-09	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Ultrasound Covington - Ultrasound	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-10	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Diagnostic Center Independence - Diagnostic Imaging	135 Courthouse Crossing	Independence	KY	Active
RRC180035-11	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Imaging Center Alexandria - Imaging	7200 Alexandria Pike	Alexandria	KY	Active
RRC180035-12	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Women's Wellness Covington - Women's Wellness	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-13	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood X-Ray/Flouroscopy - X-Ray/Flouroscopy	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-14	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Diagnostic Imaging Covington - Diagnostic Imaging	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-15	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Precision Medicine - Precision Medicine	711 Medical Village Dr.	Edgewood	KY	Active
RRC180035-16	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Imaging Hebron - Imaging	2200 Conner Rd.	Hebron	KY	Active
RRC180035-17	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Sports Medicine/PT Florence - Sports Medicine/PT	10095 Investment Way	Florence	KY	Active
RRC180035-18	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood PT Alexandria - PT	7200 Alexandria Pike	Alexandria	KY	Active
RRC180035-19	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood PT Crestview - PT	741 Centre View Blvd.	Crestview Hills	KY	Active
RRC180035-20	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood EMG - EMG	2670 Chancellor Dr.	Crestview Hills	KY	Active
RRC180035-21	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood PT Covington - PT	1500 James Simpson Jr Way	Covington	KY	Active
RRC180035-22	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood PT Burlington - PT	5874 Veterans Way	Burlington	KY	Active
RRC180035-23	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood CHF Clinic - Cardiac Care Clinic	711 Medical Village Dr.	Edgewood	KY	Active
RRC180035-24	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Sports Medicine Wilder - Sports Medicine	106 Crossing Dr.	Wilder	KY	Active
RRC180035-25	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Sports Medicine - Griffin - Sports Medicine	700 Dolwick Dr.	Erlanger	KY	Active
RRC180035-26	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Speech Pathology/Audiology MOB - Speech Pathology/Audiology	20 Medical Village Dr.	Edgewood	KY	Active
RRC180035-27	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Wound Care Covington - Wound Care	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-28	Child	RRC	ST ELIZABETH HEALTHCARE	Cardiac Health Center - Cardiac Health	711 Medical Village Drive	Edgewood	KY	Active
RRC180035-29	Child	RRC	ST ELIZABETH HEALTHCARE	Vascular Imaging Center MOB - Vascular Imaging	20 Medical Village Dr.	Edgewood	KY	Active
RRC180035-30	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Cardiac Physician Services - Cardiac Services	711 Medical Village Dr.	Edgewood	KY	Active
RRC180035-31	Child	RRC	ST ELIZABETH HEALTHCARE	Cardiac Diagnostic Medical Village - Cardiac Diagnostic	711 Medical Village Dr.	Edgewood	KY	Active
RRC180035-32	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Respiratory Therapy Covington - Respiratory Therapy	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-33	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Surgery Center Crestview Hills - Surgery Center	2845 Chancellor Blvd.	Crestview Hills	KY	Active
RRC180035-34	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Surgery Center - Surgery Center	580 South Loop Road	Edgewood	KY	Active
RRC180035-35	Child	RRC	ST ELIZABETH HEALTHCARE	Covington-EKG/EEG - EKG/EEG	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-36	Child	RRC	ST ELIZABETH HEALTHCARE	Covington Medication Management Clinic - Medication Management Clinic	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-37	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Medicine Management Clinic Crestview Hills - Medicine Management	651 Centre View Blvd.	Crestview Hills	KY	Active
RRC180035-38	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Medicine Management Clinic MOB - Medicine Management	20 Medical Village Dr.	Edgewood	KY	Active
RRC180035-39	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Hyperbaric Covington - Hyperbaric	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-40	Child	RRC	ST ELIZABETH HEALTHCARE	Edgewood Clinic Union - Clinic	10095 Investment Way	Florence	KY	Active
RRC180035-41	Child	RRC	ST ELIZABETH HEALTHCARE	Covington ER - ER	1500 James Simpson Jr. Way	Covington	KY	Active
RRC180035-42	Child	RRC	ST ELIZABETH HEALTHCARE	Hospice Home Care - Hospice Home Care	483 South Loop Rd.	Edgewood	KY	Active
RRC180035-43	Child	RRC	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Dearborn Cancer Care Infusion - Cancer Care Infusion	17525 Greendale Plaza Dr.	Lawrenceburg	IN	Active
RRC180035-44	Child	RRC	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Dearborn Cancer Care Clinic - Cancer Care Clinic	17525 Greendale Plaza Dr.	Lawrenceburg	IN	Active
RRC180035-45	Child	RRC	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Rheumatology CVH - Rheumatology	651 Centre View Blvd.	Crestview Hills	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Primary Contact	Update	PC Change Request	Thamann, Joe Director of Reimbursement St. Elizabeth Healthcare 8596551889	Hornberger, Ron Director of Reimbursement St. Elizabeth Healthcare 8596557831	1/31/2025 7:10 AM
Contacts	Signed By	Insert	New Registration		Ritchey-Baldwin, Lori CFO St. Elizabeth Healthcare 8596551642	1/27/2025 9:50 AM
Details	340B ID	Update	New Registration		RRC180035-43	1/27/2025 9:50 AM
Details	Entity Subname	Update	New Registration	St. Elizabeth Edgewood Dearborn Cancer Care Infusion	St. Elizabeth Edgewood Dearborn Cancer Care Infusion - Cancer Care Infusion	1/27/2025 9:50 AM
Dates	Participating Approval Date	Update	New Registration		1/27/2025 9:50:25 AM	1/27/2025 9:50 AM
Details	State	Update	New Registration	Pending	Approved	1/27/2025 9:50 AM
Dates	Signed By Date	Update	New Registration		1/14/2025 4:34:32 PM	1/27/2025 9:50 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/27/2025 9:50 AM
Addresses	Main Address	Insert	New Registration		17525 Greendale Plaza Dr. Lawrenceburg, IN 47025	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		300024657	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01013671	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7645114	1/13/2025 3:57 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/13/2025 3:57 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467492421	1/13/2025 3:57 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	1/13/2025 3:57 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467492421	1/13/2025 3:57 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/13/2025 3:57 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467492421	1/13/2025 3:57 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/13/2025 3:57 PM
Contacts	Primary Contact	Insert	New Registration		Thamann, Joe Director of Reimbursement St. Elizabeth Healthcare 8596551889	1/13/2025 3:57 PM
Contacts	Authorizing Official	Insert	New Registration		Ritchey-Baldwin, Lori CFO St. Elizabeth Healthcare 8596551642	1/13/2025 3:57 PM
Details	Assistance Received From Date	Insert	New Registration			1/13/2025 3:57 PM
Details	Assistance Received To Date	Insert	New Registration			1/13/2025 3:57 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2025 3:57 PM
Details	Grant Number	Insert	New Registration			1/13/2025 3:57 PM
Details	340B ID	Insert	New Registration			1/13/2025 3:57 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2025 3:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2025 3:57 PM
Details	Medicare Provider Number	Insert	New Registration		180035	1/13/2025 3:57 PM
Details	Entity Name	Insert	New Registration		ST ELIZABETH HEALTHCARE	1/13/2025 3:57 PM
Details	NOFO Number	Insert	New Registration			1/13/2025 3:57 PM
Details	Program Code	Insert	New Registration		RRC	1/13/2025 3:57 PM
Details	Entity Subname	Insert	New Registration		St. Elizabeth Edgewood Dearborn Cancer Care Infusion	1/13/2025 3:57 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2025 3:57 PM
Details	State	Insert	New Registration		Pending	1/13/2025 3:57 PM
Dates	Registration Date	Insert	New Registration		1/13/2025 3:57:44 PM	1/13/2025 3:57 PM
Dates	Signed By Date	Insert	New Registration			1/13/2025 3:57 PM
Dates	Start Date	Insert	New Registration			1/13/2025 3:57 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2025 3:57 PM
Terminations	Termination Date	Insert	New Registration			1/13/2025 3:57 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2025 3:57 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2025 3:57 PM