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AETNA SPECIALTY PHARMACY, LLC
CAH181302-00 JAMES B HAGGIN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JAMES B HAGGIN MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181302-00
Entity Address
464 LINDEN AVENUE
HARRODSBURG, KY 40330
Medicare Provider Number
181302
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AETNA SPECIALTY PHARMACY, LLC
Pharmacy Address
503 SUNPORT LN
ORLANDO, FL 32809-7874
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Lynne Warner Lynn, Hospital Administrator
(859) 239-2329
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2019
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