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DSH180036A OUR LADY OF BELLEFONTE HOSPITAL (Terminated)
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Main Details
Name
OUR LADY OF BELLEFONTE HOSPITAL
Subdivision Name
Outpatient Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180036A
Medicare Provider Number
180036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
7/1/2020
Site closure
Contacts
Authorizing Official
Bon Secours Mercy Health System
Tyler Walters, Chief Financial Officer
(606) 833-3913
Primary Contact
Bon Secours
Coley W Deal, 340B Program Manager
(804) 221-4837
Addresses
Street Address
200 St. Christopher Drive
Ashland, KY 41101
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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