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KENTUCKY CVS PHARMACY, L.L.C.
DSH180088 NORTON HOSPITALS, INC
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Covered Entity Details
Entity Name
NORTON HOSPITALS, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180088
Entity Address
200 East Chestnut Street
LOUISVILLE, KY 40202
Medicare Provider Number
180088
Participating Start Date
1/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06199
3130 PORTLAND AVE.
LOUISVILLE, KY 40212
Pharmacy Comments
Contract Details
Approval Date
4/4/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Adam David Kempf, CFO
(502) 420-2255
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2020
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