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DSH180040BT JEWISH HOSPITAL & ST MARYS HEALTH (Terminated)
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Main Details
Name
JEWISH HOSPITAL & ST MARYS HEALTH
Subdivision Name
Jewish Hospital DBA STS Mary & Elizabeth Hospital / Jewish Hospital DBA STS Mary & Elizabeth Hospital Anethesiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180040BT
Medicare Provider Number
180040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/24/2015
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
KentuckyOne Health
Adam Crone, Pharmacy Director
(502) 367-3342
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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