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HARNESS HEALTH PHARMACY
RRC180102-00 MERCY HEALTH LOURDES HOSPITAL LLC
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Covered Entity Details
Entity Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC180102-00
Entity Address
1530 LONE OAK ROAD
PADUCAH, KY 42003
Medicare Provider Number
180102
Participating Start Date
1/1/2017
Last Recertification Date
8/31/2019
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR STE 331
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Alan Archbold, Chief Financial Officer Kentucky Region
(270) 444-2553
Contract Pharmacy Representative
Bon Secours Mercy Health
Behlan Ersoy, System Director Specialty Pharmacy
(513) 557-7661
Signed By Date
1/10/2020
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