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ACCREDO HEALTH GROUP, INC.
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
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alan Archbold, Chief Financial Officer Kentucky Region
(270) 444-2553
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
1/14/2022
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