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DSH180102F MERCY HEALTH LOURDES HOSPITAL LLC (Terminated)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Cardiology & Vascular Testing / LMP Vascular Lab - Cardiology & Vascular Testing / LMP Vascular Lab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180102F
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
8/29/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
Bon Secours Mercy Health
Daniel Thomas Warren, Market CFO
(270) 444-2553
Primary Contact
Bon Secours Mercy Health
Autumn Fairfield, 340B Manager
(270) 217-4090
Addresses
Street Address
225 Medical Center Dr.
Suite 401
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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April 2025
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