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ARH SPECIALTY PHARMACY
DSH180069 TUG VALLEY ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TUG VALLEY ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180069
Entity Address
260 HOSPITAL DRIVE
SOUTH WILLIAMSON, KY 41503
Medicare Provider Number
180069
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ARH SPECIALTY PHARMACY
Pharmacy Address
DBA OF APPALACHIAN REGIONAL HEALTHCARE,
200 MEDICAL CENTER DR
SUITE A
HAZARD, KY 41701-9466
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2018
Ownership change
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Appalachian Regional Healthcare, Inc
Michael Herald, Associate Vice President of Pharmaceutical Services
(606) 438-1210
Signed By Date
7/17/2018
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