340B Drug Pricing Program Database
COMMCARE PHARMACY-FTL, LLC
DSH180103D Baptist Health Lexington - information as of 5/12/2025 1:08:16 AM
Covered Entity Details
Entity Name
Baptist Health Lexington
Subdivision Name
Baptist Health Lexington Outpatient Oncology
Type
Disproportionate Share Hospital
340B ID
DSH180103D
Entity Address
1700 Nicholasville Rd
Lexington, KY 40503
Medicare Provider Number
180103
Outpatient Facility Provider Number
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/19/2019
Ownership change
Contacts
Covered Entity Signing Official
Bill Sisson, President
(859) 260-6104
Contract Pharmacy Representative
Commcare Specialty Pharmacy
Bob Raffalo, VP Operations
(954) 284-2384
Signed By Date
10/12/2018
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