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FOOD CITY PHARMACY #425
DSH180069 TUG VALLEY ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TUG VALLEY ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180069
Entity Address
260 HOSPITAL DRIVE
SOUTH WILLIAMSON, KY 41503
Medicare Provider Number
180069
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FOOD CITY PHARMACY #425
Pharmacy Address
28093 THOMPSON PLAZA
PO BOX 2719
SOUTH WILLIAMSON, KY 41503
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
K-VA-T Food Stores, Inc
Mickey Blazer, Pharmacy Director
(423) 247-1961
Signed By Date
7/7/2020
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