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DSH180102H MERCY HEALTH LOURDES HOSPITAL LLC (Active)
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Main Details
Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
MH - Physical & Pain Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180102H
Medicare Provider Number
180102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2021
Participating Start Date
7/1/2021
Participating Approval Date
6/3/2021
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
1532 Lone Oak Rd
Suite 320
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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