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RRC330011-12 OUR LADY OF LOURDES MEMORIAL HOSP (Terminated)
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Main Details
Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
LOURDES LAB SERVICES
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330011-12
Medicare Provider Number
330011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/9/2016
Last Recertification Date
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Our Lady of Lourdes Memorial Hospital, Inc.
Kathryn Connerton, CEO
(607) 798-5328
Primary Contact
Our Lady of Lourdes Memorial Hospital, Inc.
Paul Mollo, Director - Pharmacy
(607) 798-5777
Addresses
Street Address
26S WASHINGTON ST
BINGHAMTON, NY 13903-1710
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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