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MAIN STREET PHARMACY
CAH181304-00 Trigg County Hospital, Inc.
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Covered Entity Details
Entity Name
Trigg County Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181304-00
Entity Address
254 Main Street
Cadiz, KY 42211
Medicare Provider Number
181304
Participating Start Date
1/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MAIN STREET PHARMACY
Pharmacy Address
289 MAIN ST
CADIZ, KY 42211-9151
Pharmacy Comments
Contract Details
Approval Date
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Sumner, CEO
(270) 522-3215 Ext: 3601
Contract Pharmacy Representative
Trigg County Hospital
Ashland Todd Price, R.Ph.
(270) 522-2551
Signed By Date
4/2/2019
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