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DSH180009AV KING'S DAUGHTERS MEDICAL CENTER (Active)
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Main Details
Name
KING'S DAUGHTERS MEDICAL CENTER
Subdivision Name
RUSSELL URGENT CARE CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180009AV
Medicare Provider Number
180009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
King's Daughters Medical Center
Sara Marks, Interim CEO
(606) 408-4401
Primary Contact
King's Daughters Medical Center
Debbie Bell, 340B Coordinator
(606) 408-9503
Addresses
Street Address
398 DIEDERICH BLVD
RUSSELL, KY 41169
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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