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DSH180102E MERCY HEALTH LOURDES HOSPITAL LLC (Active)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
MH - Paducah Wound Care & Hyperbaric
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180102E
Medicare Provider Number
180102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/27/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/28/2020
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Daniel Thomas Warren, Market CFO
(270) 444-2553
Primary Contact
Bon Secours Mercy Health
Sarah Lee Forthman, Director of Pharmacy
(270) 444-2289
Addresses
Street Address
225 Medical Center Dr.
Suite 205
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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