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RRC180102-00 MERCY HEALTH LOURDES HOSPITAL LLC (Terminated)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC180102-00
Medicare Provider Number
180102
Additional Details
Current Program Status
Terminated
Registration Date
10/17/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/28/2016
Last Recertification Date
8/31/2019
Termination Date
Termination Reason
10/1/2020
Change of covered entity type
Contacts
Authorizing Official
Lourdes Hospital
Alan Archbold, Chief Financial Officer Kentucky Region
(270) 444-2553
Primary Contact
Mercy Health - Lourdes Hospital
Alisa Fish, Director of Pharmacy
(270) 444-2774
Addresses
Street Address
1530 LONE OAK ROAD
PADUCAH, KY 42003
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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