340B Drug Pricing Program Database
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DSH180051R JENNIE STUART MEDICAL CENTER (Active)
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Main Details
Name
JENNIE STUART MEDICAL CENTER
Subdivision Name
JENNIE STUART DERMATOLOGY - JENNIE STUART DERMATOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180051R
Medicare Provider Number
180051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/22/2023
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Jennie Stuart Medical Center
Beth McCraw, VP Nursing Services
(270) 887-0100 Ext: 1463
Primary Contact
Jennie Stuart Medical Center
Angela N Bradt, PharmD
(270) 887-0166
Addresses
Street Address
10755 EAGLE WAY
STE 202
HOPKINSVILLE, KY 42240-8742
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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