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VALLEY DISCOUNT PHARMACY
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
VALLEY DISCOUNT PHARMACY
Pharmacy Address
6758 US HIGHWAY 23 S
SUITE 7
PIKEVILLE, KY 41501-3724
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/30/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHELLE HAGY, CFO
(606) 430-3519
Contract Pharmacy Representative
Valley Discount Pharmacy
Celina Howell, Owner
(606) 639-2415
Signed By Date
1/7/2019
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