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LYON DRUG STORE
CAH181322-00 CALDWELL COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CALDWELL COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181322-00
Entity Address
100 MEDICAL CENTER DRIVE
PRINCETON, KY 42445
Medicare Provider Number
181322
Participating Start Date
10/1/2018
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
LYON DRUG STORE
Pharmacy Address
201 W MAIN ST
PO BOX 490
EDDYVILLE, KY 42038-7752
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Harold Daniel Odegaard, CEO
(270) 365-0321
Contract Pharmacy Representative
Lyon Drug Store
Edwin Nickell, President
(270) 388-2236
Signed By Date
4/11/2019
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