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HARNESS HEALTH PHARMACY
DSH180036 OUR LADY OF BELLEFONTE HOSPITAL
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Covered Entity Details
Entity Name
OUR LADY OF BELLEFONTE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180036
Entity Address
1000 ST. CHRISTOPHER DRIVE
ASHLAND, KY 41101
Medicare Provider Number
180036
Participating Start Date
10/1/2004
Last Recertification Date
9/13/2019
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR
SUITE 330
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
1/17/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Halter, CEO
(606) 833-3600
Contract Pharmacy Representative
Mercy Health Pharmacy
Scott Spille, System Director - Retail Pharmacy
(859) 814-9786
Signed By Date
1/17/2019
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