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DSH180035M ST ELIZABETH HEALTHCARE (Terminated)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Cardiac Diagnostics / Medical Village
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180035M
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
8/26/2021
Termination Date
Termination Reason
4/1/2022
Site closure
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
711 Medical Village Dr.
Edgewood, KY 41017
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2016, Terminated 7/1/2016, Reinstated 10/1/2016.
08/24/2016
5/12/16 Participated 10/1/15 until terminated 1/1/16, reinstated effective 7/1/16
05/12/2016
April 2025
April 2025
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