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RRC330011-36 OUR LADY OF LOURDES MEMORIAL HOSP (Active)
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Main Details
Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
Vestal Walk-in
Type
Rural Referral Center
Rural
Yes
340B ID
RRC330011-36
Medicare Provider Number
330011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/6/2024
Last Recertification Date
Contacts
Authorizing Official
Guthrie Lourdes Hospital
Kathryn Connerton, President
(607) 798-5328
Primary Contact
Guthrie Lourdes Hospital
Paul Mollo, Sr. VP, Chief Pharmacy Officer
(607) 727-5577
Addresses
Street Address
3101 SHIPPERS RD
Vestal, NY 13850
Billing Address
Guthrie
The Guthrie Clinic
ONe Guthrie Square
Sayre, PA 18840
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date1/1/2017, Termination 1/1/2018, Reinstatement 1/1/2025
10/16/2024
June 2025
June 2025
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