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RRC330011-55 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 - Weight Loss/Cardiometabolic Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330011-55
Medicare Provider Number
330011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/4/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/30/2024
Last Recertification Date
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
501 Reynolds Rd
Johnson City, NY 13790
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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