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HARNESS HEALTH PHARMACY-CENTRAL 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-CENTRAL PHARMACY
Pharmacy Address
DBA HARNESS HEALTH PHARMACY #330
7160 INDUSTRIAL ROW DR STE 330
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
11/4/2024
Contract Begin Date
11/7/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Thomas Warren, Market CFO
(270) 444-2553
Contract Pharmacy Representative
Harness Health Pharmacy
Brent Kovalyak, System Director of Pharmacy Operations
(513) 305-6835
Signed By Date
11/4/2024
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