Covered Entity Details

DSH180043 AdventHealth Manchester (Active)

Main Details

Name

AdventHealth Manchester

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180043

Medicare Provider Number

180043

Additional Details

Current Program Status

Active

Registration Date

7/1/2005

Participating Start Date

10/1/2017

Participating Approval Date

6/1/2005

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

AdventHealth Manchester
Jesse Kleven, VP/CFO AdventHealth Manchester
(606) 598-1035

Primary Contact

Adventhealth
Rafael Kirkpatrick, SE Region 340B Coordinator
(956) 466-8487

Addresses

Street Address

210 MARIE LANGDON DRIVE
MANCHESTER, KY 40962

Billing Address

AdventHealth Manchester
c/o AdventHealth
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714

Comment	Last Updated On
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7/31/17 Participated as a DSH starting 7/1/05 and terminated on 7/1/2014. Started participating as a SCH on 7/1/2014 through 9/30/17 and will be participating as a DSH starting 10/1/17.	07/31/2017
6/16/14-Changed participation from DSH to SCH effective 0701/2014;2/23/12 add new bill to address; 2/15/12 updaet Medicaid number - previous54025796 RURAL NEW ENTRY 7/05	06/16/2014
2/23/12 add new bill to address 2/15/12 updaet Medicaid number - previous54025796 RURAL NEW ENTRY 7/05	02/23/2012
2/15/12 updaet Medicaid number - previous54025796 RURAL NEW ENTRY 7/05	02/15/2012
RURAL NEW ENTRY 7/05	04/13/2011

340B Drug Pricing Program Database