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CUMBERLAND DRUG CO
DSH180050 HARLAN ARH HOSPITAL
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Covered Entity Details
Entity Name
HARLAN ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180050
Entity Address
81 BALL PARK ROAD
HARLAN, KY 40831
Medicare Provider Number
180050
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CUMBERLAND DRUG CO
Pharmacy Address
CUMBERLAND DRUG
1803 E MAIN ST
CUMBERLAND, KY 40823-1840
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Harlan Medical Center
Ernie Watts, Owner/Operator
(606) 589-0003
Signed By Date
1/15/2020
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