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AZ PHARMACY, LLC
CAH181325-00 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
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Covered Entity Details
Entity Name
JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181325-00
Entity Address
290 Industrial Park Road
GREENSBURG, KY 42743
Medicare Provider Number
181325
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
AZ PHARMACY, LLC
Pharmacy Address
DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034
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
(270) 932-9696 Ext: 25
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
4/13/2019
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