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ELKHORN DRUG INC
DSH180044 PIKEVILLE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PIKEVILLE MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180044
Entity Address
911 BYPASS ROAD
PIKEVILLE, KY 41501
Medicare Provider Number
180044
Participating Start Date
1/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ELKHORN DRUG INC
Pharmacy Address
105 E ELKHORN ST.
PO BOX 532
ELKHORN CITY, KY 41522
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELLE HAGY, CFO
(606) 430-3519
Contract Pharmacy Representative
Elkhorn Drug
Robert Lester, Owner
(606) 754-0221
Signed By Date
10/15/2018
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