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DSH180045 ST. ELIZABETH FLORENCE (Terminated)
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Main Details
Name
ST. ELIZABETH FLORENCE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180045
Medicare Provider Number
180045
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/17/2016
Last Recertification Date
9/2/2019
Termination Date
Termination Reason
10/1/2020
DSH percentage below statutory minimum
Contacts
Authorizing Official
St. Elizabeth Healthcare
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Primary Contact
St. Elizabeth Healthcare
Joe Thamann, Director of Reimbursement
(859) 655-1889
Addresses
Street Address
4900 HOUSTON ROAD
FLORENCE, KY 41042-4824
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/17/16 Participating 10/2/2015 until terminated effective 1/1/2016, reinstated effective 10/1/2016
08/17/2016
Participating 10/2/2015 until terminated effective 1/1/2016, reinstated 7/1/2016;
04/29/2016
10/2/15 Previously participated from 4/1/11 through 7/1/12 at the request of the covered entity, registration was submitted in July 2015, approval was delayed until 10/2/15, reinstatement effective 10/2/15;
10/02/2015
10/2/15 Previously participated from 4/1/11 through 7/1/12 at the request of the covered entity, Reinstatement effective 10/2/15.
10/02/2015
04/07/11 REMOVE MEDICAID #(WAS 7100116650)
04/07/2011
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