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RRC330011-19 OUR LADY OF LOURDES MEMORIAL HOSP (Terminated)
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Main Details
Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
Lourdes Endocrinology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330011-19
Medicare Provider Number
330011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2016
Participating Start Date
3/15/2022
Participating Approval Date
3/9/2016
Last Recertification Date
8/22/2023
Termination Date
Termination Reason
1/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Our Lady of Lourdes Memorial Hospital, Inc.
Kathryn Connerton, CEO
(607) 798-5328
Primary Contact
Ascension Rx
Paul Mollo, National Director Medication Outcomes Disparity
(607) 798-5715
Addresses
Street Address
169 Riverside Dr
Binghamton, NY 13905
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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