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RRC180035-12 ST ELIZABETH HEALTHCARE (Active)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Edgewood Women's Wellness Covington - Women's Wellness
Type
Rural Referral Center
Rural
No
340B ID
RRC180035-12
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/27/2025
Last Recertification Date
Contacts
Authorizing Official
St. Elizabeth Healthcare
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Primary Contact
St. Elizabeth Healthcare
Ron Hornberger, Director of Reimbursement
(859) 655-7831
Addresses
Street Address
1500 James Simpson Jr. Way
Covington, KY 41011
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2024) until terminated effective date: (04/01/2024); reinstatement effective date: (04/01/2025)
01/16/2025
April 2025
April 2025
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