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CAH181301-01 Marcum & Wallace Memorial Hospital (Active)
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Main Details
Name
Marcum & Wallace Memorial Hospital
Subdivision Name
Mercy Health - Irvine Primary Care
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH181301-01
Medicare Provider Number
181301
Outpatient Facility Provider Number
183462
Additional Details
Current Program Status
Active
Registration Date
1/9/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/16/2013
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Daniel Thomas Warren, Market CFO
(270) 444-2553
Primary Contact
Mercy Health-Marcum & Wallace Hospital, LLC
Lisa Patton, Manager of Pharmacy
(606) 726-2146
Addresses
Street Address
1100 Richmond Rd
Irvine, KY 40336
Billing Address
Mercy Health-Marcum and Wallace Hospital, LLC.
60 Mercy Court
Irvine, KY 40336
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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