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DSH180040BR JEWISH HOSPITAL & ST MARYS HEALTH (Terminated)
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Main Details
Name
JEWISH HOSPITAL & ST MARYS HEALTH
Subdivision Name
JEWISH HOSPITAL MEDICAL CENTER NORTHEAST / INFUSION CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180040BR
Medicare Provider Number
180040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
University of Louisville Hospital
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Primary Contact
Katy Brogan, Pharmacy Manager
(502) 562-7036
Addresses
Street Address
2401 TERRA CROSSING BOULEVARD
LOUISVILLE, KY 40245
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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