Contract Pharmacy Details

KENTUCKY CVS PHARMACY, L.L.C.
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HAZARD ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180029

Entity Address

100 MEDICAL CENTER DRIVE
HAZARD, KY 41701

Medicare Provider Number

180029

Participating Start Date

10/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

KENTUCKY CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06343
30 S KY HIGHWAY 15
HAZARD, KY 41701

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

7/9/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/1/2023
Pharmacy closed

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

340B Drug Pricing Program Database