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CAVE CITY PRESCRIPTION CENTER, INC.
DSH180017 TJ SAMSON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
TJ SAMSON COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180017
Entity Address
1301 NORTH RACE STREET
GLASGOW, KY 42141
Medicare Provider Number
180017
Participating Start Date
7/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CAVE CITY PRESCRIPTION CENTER, INC.
Pharmacy Address
101 SOUTH DIXIE HWY
P.O. BOX 596
CAVE CITY, KY 42127-4212
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
8/5/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Neil Thornbury, CEO
(270) 651-4159
Contract Pharmacy Representative
Cave City Prescription Center, Inc.
Micaela Riemer, Pharmacist/Owner
(270) 773-2252
Signed By Date
7/7/2020
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