340B Drug Pricing Program Database


DSH180013 THE MEDICAL CENTER - BOWLING GREEN (Active) - information as of 4/29/2025 11:58:26 PM

Main Details
THE MEDICAL CENTER - BOWLING GREEN
Disproportionate Share Hospital
No
DSH180013
180013


Additional Details
Active
10/18/2007
4/1/2005
10/18/2007
9/6/2024

Contacts

Med Center Health
Wade R. Stone, Executive Vice President
(270) 745-1504

Commonwealth Health Corporation
Caleb Benningfield, Pharmacist
(270) 745-1640

Addresses

250 PARK STREET
BOWLING GREEN, KY 42101

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
3/7/12 add npi03/07/2012
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
KY010111541043293608
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailHOUCHENS EXPRESS PHARMACY LLCDBA SHELDON'S EXPRESS PHARMACY 843 FAIRVIEW AVE STE A1
BOWLING GREENKY42101-491410/11/201210/11/2012 02/29/201603/01/2016
Contract DetailKENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06422 704 US 31W BYP
BOWLING GREENKY4210107/12/201310/01/2013 06/30/201506/29/2015
Contract DetailKENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06423 1122 LOVERS LANE
BOWLING GREENKY4210307/12/201310/01/2013 06/30/201506/29/2015
Contract DetailKROGER PHARMACY #L-5852945 SCOTTSVILLE ROAD
BOWLING GREENKY4210412/21/201212/21/2012 02/29/201603/01/2016
Contract DetailKROGER PHARMACY L-509711 CAMPBELL LANE
BOWLING GREENKY4210412/21/201212/21/2012 02/29/201603/01/2016
Contract DetailKROGER PHARMACY L-535350 US 31W BYP
BOWLING GREENKY4210112/21/201212/21/2012 02/29/201603/01/2016
Contract DetailRIVERSIDE PHARMACY825 SECOND AVENUE EAST SUITE A1
BOWLING GREENKY4210110/05/201210/05/2012 02/29/201603/01/2016
Contract DetailRIVERSIDE PHARMACY825 SECOND AVENUE EAST SUITE A1
BOWLING GREENKY4210107/11/202310/01/2023  10/01/2023
Contract DetailUK - SPECIALTY PHARMACYUNIVERSITY OF KENTUCKY HOSPITAL 800 ROSE ST RM HC 201
RM HC201 		LEXINGTONKY40536-700110/12/201701/01/2018 03/26/202007/18/2022
Contract DetailWAL-MART PHARMACY 10-02821550 NASHVILLE ROAD
FRANKLINKY4213410/31/201210/31/2012 06/30/201506/29/2015
Contract DetailWAL-MART PHARMACY 10-0299150 WALTON AVENUE
BOWLING GREENKY4210410/31/201210/31/2012 02/29/201603/01/2016
Contract DetailWAL-MART PHARMACY 10-07112345 HAPPY VALLEY RD.
GLASGOWKY4214110/31/201210/31/2012 06/30/201506/29/2015
Contract DetailWAL-MART PHARMACY 10-0736120 SAM WALTON DRIVE
RUSSELLVILLEKY4227610/31/201210/31/2012 02/29/201603/01/2016
Contract DetailWAL-MART PHARMACY 10-52361201 MORGANTOWN ROAD
BOWLING GREEN (NW)KY4210110/31/201210/31/2012 02/29/201603/01/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04448 1145 U.S. 31 W. BYPASS
BOWLING GREENKY4210104/06/201507/01/2015  04/06/2015
Contract DetailWALGREEN CO.DBA: WALGREENS # 07685 2385 NASHVILLE ROAD
BOWLING GREENKY42101-414404/06/201507/01/2015  04/06/2015
Contract DetailWALGREEN CO.DBA: WALGREENS #13815 2824 SCOTTSVILLE RD.
BOWLING GREENKY4210404/06/201507/01/2015  04/06/2015
Contract DetailWalgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101 		MemphisTN3811804/13/202307/01/2023  07/01/2023
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH180013AChildDSHTHE MEDICAL CENTER - BOWLING GREENWestern Kentucky Diagnostic Imaging1635 Scottsville RdBowling GreenKYActive
DSH180013BChildDSHTHE MEDICAL CENTER - BOWLING GREENMEDICAL CENTER PSYCHIATRY - Psychiatry350 PARK STBOWLING GREENKYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/6/2023 1:39:49 PM9/6/2024 12:35:54 PM9/6/2024 12:35 PM
DetailsLast Recertification DateUpdateRecertification9/13/2022 9:22:37 AM9/6/2023 1:39:49 PM9/6/2023 1:39 PM
DetailsLast Recertification DateUpdateRecertification9/10/2021 1:55:35 PM9/13/2022 9:22:37 AM9/13/2022 9:22 AM
DetailsLast Recertification DateUpdateRecertification9/8/2020 2:15:06 PM9/10/2021 1:55:35 PM9/10/2021 1:55 PM
ContactsAuthorizing OfficialUpdateAO Change RequestJoyce, Melinda C Vice-President, Corporate Support Services Med Center Health 2707451599Stone, Wade R. Executive Vice President Med Center Health 27074515048/30/2021 8:11 AM
Medicaid BillingNPI: StateUpdateRecertification KY9/8/2020 2:15 PM
DetailsLast Recertification DateUpdateRecertification9/13/2019 8:09:32 AM9/8/2020 2:15:06 PM9/8/2020 2:15 PM
ContactsPrimary ContactUpdateRecertificationPolston, Aric Corporate Director of Pharmacy The Medical Center - Bowling Green 2707451640Benningfield, Caleb Pharmacist Commonwealth Health Corporation 27074516409/13/2019 8:09 AM
DetailsLast Recertification DateUpdateRecertification9/6/2018 11:04:10 AM9/13/2019 8:09:32 AM9/13/2019 8:09 AM
DetailsLast Recertification DateUpdateRecertification11/20/2017 2:50:36 PM9/6/2018 11:04:10 AM9/6/2018 11:04 AM
DetailsLast Recertification DateUpdateRecertification8/16/2016 12:00:00 AM11/20/2017 2:50:36 PM11/20/2017 2:50 PM
ContactsPrimary ContactUpdate Polston, Aric Corporate Director of Pharmacy 2707451640Polston, Aric Corporate Director of Pharmacy The Medical Center - Bowling Green 270745164010/12/2017 4:45 PM
ContactsAuthorizing OfficialUpdateAO Change RequestMOORE, SARAH EVP 2707451257Joyce, Melinda C Vice-President, Corporate Support Services Med Center Health 27074515999/29/2017 2:43 PM
ContactsPrimary ContactUpdate McClelland, Robert Corporate Director of Pharmacy 2707451640Polston, Aric Corporate Director of Pharmacy 27074516408/24/2016 7:12 AM
AddressesMain AddressInsert   250 PARK STREET BOWLING GREEN, KY 421018/16/2016 4:50 PM
DetailsLast Recertification DateUpdate 8/6/2015 12:00:00 AM8/16/2016 12:00:00 AM8/16/2016 4:50 PM
ContactsAuthorizing OfficialInsert  MOORE, SARAH EVP 27074512575/2/2016 10:51 AM
ContactsPrimary ContactInsert  McClelland, Robert Corporate Director of Pharmacy 27074516409/16/2015 7:56 AM
DetailsLast Recertification DateUpdate 8/8/2014 12:00:00 AM8/6/2015 12:00:00 AM8/6/2015 9:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False5/15/2015 12:08 PM
Medicaid BillingMedicaid: NumberInsert  010111545/15/2015 12:08 PM
Medicaid BillingMedicaid: StateInsert  KY5/15/2015 12:08 PM
DetailsLast Recertification DateUpdate 9/3/2013 12:00:00 AM8/8/2014 12:00:00 AM8/8/2014 10:39 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/3/2013 12:00:00 AM9/3/2013 2:30 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/15/2012 7:40 AM
Medicaid BillingNPI: NumberInsert  10432936083/7/2012 1:21 PM
DetailsComments PublicInsert  3/7/12 add npi3/7/2012 1:21 PM
DatesParticipating Approval DateUpdate 10/18/2007 6:18:57 AM10/18/2007 12:00:00 AM9/26/2011 12:11 PM
DetailsLast Recertification DateInsert   10/18/2007 6:21 AM
DetailsGrant NumberInsert   10/18/2007 6:21 AM
Details340B IDInsert  DSH18001310/18/2007 6:21 AM
DetailsIs Authorizing Official EHB DataInsert   10/18/2007 6:21 AM
DatesLast Date That 340B Drugs PurchasedInsert   10/18/2007 6:21 AM
DetailsMedicare Provider NumberInsert  18001310/18/2007 6:21 AM
DetailsEntity NameInsert  THE MEDICAL CENTER - BOWLING GREEN10/18/2007 6:21 AM
DetailsProgram CodeInsert  DSH10/18/2007 6:21 AM
DetailsEntity SubnameInsert   10/18/2007 6:21 AM
DatesParticipating Approval DateInsert  10/18/2007 6:18:57 AM10/18/2007 6:21 AM
DetailsStateInsert  Active10/18/2007 6:21 AM
DatesRegistration DateInsert  10/18/2007 12:00:00 AM10/18/2007 6:21 AM
DatesSigned By DateInsert  2/25/2005 12:00:00 AM10/18/2007 6:21 AM
DatesStart DateInsert  4/1/2005 12:00:00 AM10/18/2007 6:21 AM
TerminationsTermination CommentsInsert   10/18/2007 6:21 AM
TerminationsTermination DateInsert   10/18/2007 6:21 AM
TerminationsTermination Effective DateInsert   10/18/2007 6:21 AM
TerminationsTermination ReasonInsert   10/18/2007 6:21 AM