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RRC180102-18 MERCY HEALTH LOURDES HOSPITAL LLC (Terminated)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Lourdes Pain Management - Pain Management
Type
Rural Referral Center
Rural
Yes
340B ID
RRC180102-18
Medicare Provider Number
180102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/31/2017
Last Recertification Date
8/30/2019
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
1532 Lone Oak Road
Suite 430
Paducah, KY 42003
Billing Address
Mercy Health Lourdes Hospital LLC
1530 Lone Oak Road
Paducah, KY 42003
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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