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DSH180035AD ST ELIZABETH HEALTHCARE (Terminated)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Edge Cancer Care / MOB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180035AD
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
1/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
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
20 Medical Village Dr.
Suite 200
Edgewood, KY 41017
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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