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DSH180102A MERCY HEALTH LOURDES HOSPITAL LLC (Terminated)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Lourdes Behavioral Health Outpatient - Lourdes Behavioral Health Outpatient
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180102A
Medicare Provider Number
180102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/27/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/28/2020
Last Recertification Date
8/24/2021
Termination Date
Termination Reason
4/1/2022
Site closure
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 Rd
Suite 345
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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