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STOVALL'S PRESCRIPTION SHOP
DSH180149 TJ HEALTH COLUMBIA
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Covered Entity Details
Entity Name
TJ HEALTH COLUMBIA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180149
Entity Address
901 Wellness Way
COLUMBIA, KY 42728
Medicare Provider Number
180149
Participating Start Date
4/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
STOVALL'S PRESCRIPTION SHOP
Pharmacy Address
202 S COURT ST
PO BOX 217
SCOTTSVILLE, KY 42164-1263
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
7/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Neil Thornbury, CEO
(270) 651-4159
Contract Pharmacy Representative
STOVALL'S PRESCRIPTION SHOP
Larry Stovall, Owner
(270) 237-5402
Signed By Date
7/14/2020
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