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KENTUCKY CVS PHARMACY, L.L.C.
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
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06383
307 STURGIS RD
MARION, KY 42064
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Harold Daniel Odegaard, CEO
(270) 365-0321
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2020
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