Covered Entity Details

DSH180035AC ST ELIZABETH HEALTHCARE (Terminated) - information as of 4/25/2025 8:36:43 PM

Main Details

Name

ST ELIZABETH HEALTHCARE

Subdivision Name

Edgewood / EMG

Type

Disproportionate Share Hospital

Rural

340B ID

DSH180035AC

Medicare Provider Number

180035

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/3/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/26/2017

Last Recertification Date

8/20/2024

Termination Date
Termination Reason

4/1/2025
Change of covered entity type

Contacts

Authorizing Official

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

Primary Contact

St. Elizabeth Healthcare
Joe Thamann, Director of Reimbursement
(859) 655-1889

Addresses

Street Address

2670 Chancellor Dr.
Suite 100B
Crestview Hills, KY 41017

Billing Address

St. Elizabeth Healthcare
1 Medical Village Dr.
Edgewood, KY 41017

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
KY	01013671	1467492421
OH	7645114	1467492421
IN	300024657	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
DSH180035A	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Health Center	711 Medical Village Drive	Edgewood	KY	Terminated
DSH180035AA	Child	DSH	ST ELIZABETH HEALTHCARE	Hospice Home Care	483 South Loop Rd.	Edgewood	KY	Terminated
DSH180035AB	Child	DSH	ST ELIZABETH HEALTHCARE	COV Medication Management Clinic	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AC	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood / EMG	2670 Chancellor Dr.	Crestview Hills	KY	Terminated
DSH180035AD	Child	DSH	ST ELIZABETH HEALTHCARE	Edge Cancer Care / MOB	20 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035AE	Child	DSH	ST ELIZABETH HEALTHCARE	ST. ELIZABETH COVINGTON / MRI	1500 JAMES SIMPSON JR. WAY	COVINGTON	KY	Terminated
DSH180035AF	Child	DSH	ST ELIZABETH HEALTHCARE	ST. ELIZABETH COVINGTON / EKG/EEG	1500 JAMES SIMPSON JR. WAY	COVINGTON	KY	Terminated
DSH180035AG	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Sports Medicine - Griffin	700 Dolwick Dr.	Erlanger	KY	Terminated
DSH180035AH	Child	DSH	ST ELIZABETH HEALTHCARE	Edge Cancer Care Dearborn County - Cancer Care	606 Wilson Creek Rd	Lawrenceburg	IN	Terminated
DSH180035AJ	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Alexandria PT - Edgewood Alexandria PT	7200 Alexandria Pike	Alexandria	KY	Terminated
DSH180035AK	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Crestview PT - Edgewood Crestview PT	741 Centre View Blvd.	Crestview Hills	KY	Terminated
DSH180035AL	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Burlington PT - Edgewood Burlington PT	5874 Veterans Way	Burlington	KY	Terminated
DSH180035AM	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Covington PT - Edgewood Covington PT	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AN	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Covington Ultrasound - Edgewood Covington Ultrasound	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AP	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Covington Respiratory Therapy - Edgewood Covington Respiratory Therapy	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AQ	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Wilder Sports Medicine - Edgewood Wilder Sports Medicine	106 Crossing Dr.	Wilder	KY	Terminated
DSH180035AR	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Covington Hyperbaric - Edgewood Covington Hyperbaric	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AS	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Covington Women's Wellness - Edgewood Covington Women's Wellness	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035AT	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Women's Wellness 600 MVD - Edgewood Women's Wellness 600 MVD	600 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035AU	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood CHF Clinic - Edgewood CHF Clinic	711 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035AV	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Union Clinic - Edgewood Union Clinic	10095 Investment Way	Florence	KY	Terminated
DSH180035AW	Child	DSH	ST ELIZABETH HEALTHCARE	Edgewood Cardiac Physician Services - Edgewood Cardiac Physician Services	711 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035AX	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare - Edgewood Precision Medicine	711 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035AY	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare Edgewood Infusion Center Crestview - Edgewood Infusion Center Crestview	380 Centre View Blvd.	Crestview Hills	KY	Terminated
DSH180035AZ	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare Edge Infusion FTT - Edge Infusion FTT	85 North Grand Ave.	Ft. Thomas	KY	Terminated
DSH180035B	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics - Medical Village	711 Medical Village Drive	Edgewood	KY	Terminated
DSH180035BA	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare Edge Radiation Oncology FTT - Edge Radiation Oncology FTT	85 North Grand Ave.	Ft. Thomas	KY	Terminated
DSH180035BB	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare Edge Medical Oncology FTT - Edge Medical Oncology FTT	85 North Grand Ave.	Ft. Thomas	KY	Terminated
DSH180035BC	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Cancer Ctr. Palliative Care FTT - Palliative Care	85 North Grand Ave.	Ft. Thomas	KY	Terminated
DSH180035BD	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood CVH Medicine Management Clinic - Medicine Management	651 Centre View Blvd.	Crestview Hills	KY	Terminated
DSH180035BE	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Rheumatology Crestview Hills - Rheumatology	651 Centre View Blvd.	Crestview Hills	KY	Terminated
DSH180035BF	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Dearborn Cancer Care Infusion - Cancer Care Infusion	17525 Greendale Plaza Dr.	Greendale	IN	Terminated
DSH180035BG	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Edgewood Dearborn Cancer Care Clinic - Cancer Care	17525 Greendale Plaza Dr.	Greendale	IN	Terminated
DSH180035C	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth - US 42 Imaging	8726 US Hwy 42	Florence	KY	Terminated
DSH180035D	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Healthcare / Sports Medicine	830 Thomas More Parkway	Edgewood	KY	Terminated
DSH180035E	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics - Kenwood	8251 Pine Road	Kenwood	OH	Terminated
DSH180035F	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics - Turfway	7370 Turfway Road Suite 109	Florence	KY	Terminated
DSH180035G	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Imaging Center - Alexandria	7200 Alexandria Pike	Alexandria	KY	Terminated
DSH180035H	Child	DSH	ST ELIZABETH HEALTHCARE	Surgery Center - Edgewood	580 South Loop Road	Edgewood	KY	Terminated
DSH180035J	Child	DSH	ST ELIZABETH HEALTHCARE	Vascular Imaging Center MOB	20 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035K	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics - Medical Village	711 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035L	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Sports Medicine-Florence/Business Health	10095 Investment Way	Florence	KY	Terminated
DSH180035M	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics / Medical Village	711 Medical Village Dr.	Edgewood	KY	Terminated
DSH180035N	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Imaging Center - Edgewood	2904 Foltz Drive	Edgewood	KY	Terminated
DSH180035P	Child	DSH	ST ELIZABETH HEALTHCARE	Surgery Center - Crestview Hills	2845 Chancellor Blvd	Crestview Hills	KY	Terminated
DSH180035Q	Child	DSH	ST ELIZABETH HEALTHCARE	St. Elizabeth Imaging Center Hebron	2200 Conner Rd	Hebron	KY	Terminated
DSH180035R	Child	DSH	ST ELIZABETH HEALTHCARE	Cardiac Diagnostics - Aurora	204 Bridgeway St	Aurora	IN	Terminated
DSH180035S	Child	DSH	ST ELIZABETH HEALTHCARE	St Elizabeth Edgewood - Edge Medication Management Clinic	20 Medical Village Drive	Edgewood	KY	Terminated
DSH180035T	Child	DSH	ST ELIZABETH HEALTHCARE	St Elizabeth Edgewood / Speech Pathology/Audiology	20 Medical Village Drive	Edgewood	KY	Terminated
DSH180035U	Child	DSH	ST ELIZABETH HEALTHCARE	Independence Diagnostic Center	135 Courthouse Crossing	Independence	KY	Terminated
DSH180035V	Child	DSH	ST ELIZABETH HEALTHCARE	Covington / X-ray Flouroscopy	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035W	Child	DSH	ST ELIZABETH HEALTHCARE	Covington / Diagnostic Imaging	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035X	Child	DSH	ST ELIZABETH HEALTHCARE	Covington / Wound Care	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035Y	Child	DSH	ST ELIZABETH HEALTHCARE	Covington / Emergency Room	1500 James Simpson Jr. Way	Covington	KY	Terminated
DSH180035Z	Child	DSH	ST ELIZABETH HEALTHCARE	Hospice Unit	483 South Loop Rd.	Edgewood	KY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 9:23 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	1/27/2025 9:23 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 9:23 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 9:23 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	1/27/2025 9:23 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 9:30:57 AM	8/20/2024 9:39:43 AM	8/20/2024 9:39 AM
Addresses	Main Address	Update	Change Request	2670 Chancellor Dr. Suite 100 Crestview Hills, KY 41017	2670 Chancellor Dr. Suite 100B Crestview Hills, KY 41017	7/1/2024 1:18 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	4/1/2024 12:00:00 AM		3/8/2024 7:12 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	3/8/2024 7:12 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	4/1/2024 12:00:00 AM		3/8/2024 7:12 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	4/1/2024 12:00:00 AM		3/8/2024 7:12 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Change of covered entity type		3/8/2024 7:12 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2024 12:00:00 AM	2/27/2024 7:40 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	2/27/2024 7:40 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2024 12:00:00 AM	2/27/2024 7:40 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2024 12:00:00 AM	2/27/2024 7:40 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	2/27/2024 7:40 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 2:57:04 PM	8/25/2023 9:30:57 AM	8/25/2023 9:30 AM
Addresses	Billing Address	Insert	Change Request		St. Elizabeth Healthcare 1 Medical Village Dr. Edgewood, KY 41017	9/2/2022 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 2:03:04 PM	8/24/2022 2:57:04 PM	8/24/2022 2:57 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 10:44:46 AM	8/26/2021 2:03:04 PM	8/26/2021 2:03 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467492421	9/9/2020 10:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/9/2020 10:44 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467492421	9/9/2020 10:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/9/2020 10:44 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467492421	9/9/2020 10:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/9/2020 10:44 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1467492421 ( )		9/9/2020 10:44 AM
Details	Last Recertification Date	Update	Recertification	8/31/2019 7:36:01 AM	9/9/2020 10:44:46 AM	9/9/2020 10:44 AM
Medicaid Billing	Medicaid: Number	Update	Recertification	100034230A	300024657	8/31/2019 7:36 AM
Details	Last Recertification Date	Update	Recertification	8/20/2018 9:07:20 AM	8/31/2019 7:36:01 AM	8/31/2019 7:36 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 7:50:25 AM	8/20/2018 9:07:20 AM	8/20/2018 9:07 AM
Details	Last Recertification Date	Update	Recertification		11/6/2017 7:50:25 AM	11/6/2017 7:50 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	10034230A	100034230A	10/25/2017 9:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/23/2017 4:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10034230A	10/23/2017 4:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	10/23/2017 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2017 8:14 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7645114	10/10/2017 8:14 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	10/10/2017 8:14 AM
Contacts	Authorizing Official	Update		Ritchey-Baldwin, Lori CFO 8596551642	Ritchey-Baldwin, Lori CFO St. Elizabeth Healthcare 8596551642	10/2/2017 12:55 PM
Contacts	Signed By	Update		Ritchey-Baldwin, Lori CFO 8596551642	Ritchey-Baldwin, Lori CFO St. Elizabeth Healthcare 8596551642	10/2/2017 12:55 PM
Contacts	Primary Contact	Update		Thamann, Joe Director of Reimbursement 8596551889	Thamann, Joe Director of Reimbursement St. Elizabeth Healthcare 8596551889	9/26/2017 3:44 PM
Addresses	Main Address	Insert			2670 Chancellor Dr. Suite 100 Crestview Hills, KY 41017	7/12/2017 4:02 PM
Contacts	Primary Contact	Insert			Thamann, Joe Director of Reimbursement 8596551889	7/12/2017 4:02 PM
Contacts	Authorizing Official	Insert			Ritchey-Baldwin, Lori CFO 8596551642	7/12/2017 4:02 PM
Contacts	Signed By	Insert			Ritchey-Baldwin, Lori CFO 8596551642	7/12/2017 4:02 PM
Dates	Participating Approval Date	Update			4/26/2017 12:00:00 AM	4/26/2017 9:59 AM
Details	State	Update		Pending	Active	4/26/2017 9:59 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/26/2017 9:59 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_75739	DSH180035AC	4/4/2017 9:10 AM
Details	Entity Subname	Update		Edgewood EMG / Edgewood EMG	Edgewood / EMG	4/4/2017 9:10 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_75739	4/3/2017 11:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2017 11:09 AM
Medicaid Billing	Medicaid: Number	Insert			01013671	4/3/2017 11:09 AM
Medicaid Billing	Medicaid: State	Insert			KY	4/3/2017 11:09 AM
Medicaid Billing	NPI: Number	Insert			1467492421	4/3/2017 11:09 AM
Details	Last Recertification Date	Insert				4/3/2017 11:09 AM
Details	Grant Number	Insert				4/3/2017 11:09 AM
Details	340B ID	Insert				4/3/2017 11:09 AM
Details	Is Authorizing Official EHB Data	Insert				4/3/2017 11:09 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2017 11:09 AM
Details	Medicare Provider Number	Insert			180035	4/3/2017 11:09 AM
Details	Entity Name	Insert			ST ELIZABETH HEALTHCARE	4/3/2017 11:09 AM
Details	Program Code	Insert			DSH	4/3/2017 11:09 AM
Details	Entity Subname	Insert			Edgewood EMG / Edgewood EMG	4/3/2017 11:09 AM
Dates	Participating Approval Date	Insert				4/3/2017 11:09 AM
Details	State	Insert			Pending	4/3/2017 11:09 AM
Dates	Registration Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 11:09 AM
Dates	Signed By Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 11:09 AM
Dates	Start Date	Insert				4/3/2017 11:09 AM
Terminations	Termination Comments	Insert				4/3/2017 11:09 AM
Terminations	Termination Date	Insert				4/3/2017 11:09 AM
Terminations	Termination Effective Date	Insert				4/3/2017 11:09 AM
Terminations	Termination Reason	Insert				4/3/2017 11:09 AM