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DSH180035BD ST ELIZABETH HEALTHCARE (Terminated)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
St. Elizabeth Edgewood CVH Medicine Management Clinic - Medicine Management
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180035BD
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/13/2023
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
4/1/2025
Change of covered entity type
Contacts
Authorizing Official
St. Elizabeth Healthcare
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Primary Contact
St. Elizabeth Healthcare
Joe Thamann, Director of Reimbursement
(859) 655-1889
Addresses
Street Address
651 Centre View Blvd.
102
Crestview Hills, KY 41017
Billing Address
St. Elizabeth Healthcare
1 Medical Village Dr.
Edgewood, KY 41017
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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