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RRC330011-48 OUR LADY OF LOURDES MEMORIAL HOSP (Active)
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Main Details
Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
OUR LADY OF LOURDES MEMORIAL HOSPIT - Geriatric Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330011-48
Medicare Provider Number
330011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/10/2024
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Guthrie Lourdes Hospital
Kathryn Connerton, President
(607) 798-5328
Primary Contact
Guthrie Lourdes Hospital
Paul Mollo, Sr. VP, Chief Pharmacy Officer
(607) 727-5577
Addresses
Street Address
27 JENNISON AVE
JOHNSON CITY, NY 13790-2302
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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