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HARNESS HEALTH PHARMACY
DSH180102 MERCY HEALTH LOURDES HOSPITAL LLC
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Covered Entity Details
Entity Name
MERCY HEALTH LOURDES HOSPITAL LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180102
Entity Address
1530 LONE OAK ROAD
PADUCAH, KY 42003
Medicare Provider Number
180102
Participating Start Date
10/1/2020
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR STE 331
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
9/22/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Ownership change
Contacts
Covered Entity Signing Official
Alan Archbold, Chief Financial Officer Kentucky Region
(270) 444-2553
Contract Pharmacy Representative
Harness Health Pharmacy
Behlan Ersoy, System Director Specialty Pharmacy
(513) 557-7661
Signed By Date
9/22/2020
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