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KENTUCKY CVS PHARMACY, L.L.C.
DSH180002 WHITESBURG ARH HOSPITAL
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Covered Entity Details
Entity Name
WHITESBURG ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180002
Entity Address
240 HOSPITAL ROAD
WHITESBURG, KY 41858
Medicare Provider Number
180002
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 # 06341
533 SKIDMORE DRIVE
HARLAN, KY 40831
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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