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DSH180040B UofL Health -- Louisville (Terminated)
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Main Details
Name
UofL Health -- Louisville
Subdivision Name
MARY & ELIZABETH HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180040B
Medicare Provider Number
180040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/1/2007
Participating Start Date
7/1/2004
Participating Approval Date
3/1/2007
Last Recertification Date
9/13/2020
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
University of Louisville Hospital
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Primary Contact
UofL Health
Robert Michael Fink, System Vice President, Pharmacy Services
(502) 562-3211
Addresses
Street Address
1850 BLUEGRASS AVE
LOUISVILLE, KY 40215
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/1/07 - MOD ENT NAME (WAS STS MARY & ELIZABETH HOSPITAL), CHANGED MEDICAID # (WAS 18-0037, 18-5390, 18-S037)
08/14/2007
April 2025
April 2025
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