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KENTUCKY CVS PHARMACY, L.L.C.
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
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06340
197 APPALACHIAN PLAZA
SOUTH WILLIAMSON, KY 41503
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
7/9/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/7/2020
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