Contract Pharmacy Details

KENTUCKY CENTRAL FILL FACILITY, L-010
CAH141331-00 MARSHALL BROWNING HOSPITAL ASSOCIATION

Covered Entity Details

Entity Name

MARSHALL BROWNING HOSPITAL ASSOCIATION

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH141331-00

Entity Address

900 NORTH WASHINGTON STREET
DU QUOIN, IL 62832

Medicare Provider Number

141331

Participating Start Date

10/1/2016

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

KENTUCKY CENTRAL FILL FACILITY, L-010

Pharmacy Address

5594 SHEPHERDSVILLE ROAD
LOUISVILLE, KY 40228-1012

Pharmacy Comments

Contract Details

Approval Date

4/1/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/9/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Daniel Eaves, CEO
(618) 542-1042

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

4/1/2020

340B Drug Pricing Program Database