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AHSSHC
CAH181309-00 CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181309-00
Entity Address
187 WOLFORD AVENUE
LIBERTY, KY 42539
Medicare Provider Number
181309
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
AHSSHC
Pharmacy Address
EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712
Pharmacy Comments
Contract Details
Approval Date
4/13/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard John Hendershot, CFO
(606) 787-6275 Ext: 605
Contract Pharmacy Representative
Agape
Trenia Yielding, Executive Director
(407) 357-2601
Signed By Date
4/13/2019
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