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KENTUCKY CVS PHARMACY, L.L.C.
DSH180040 UofL Health -- Louisville
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Covered Entity Details
Entity Name
UofL Health -- Louisville
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180040
Entity Address
200 ABRAHAM FLEXNER WAY
LOUISVILLE, KY 40202-1818
Medicare Provider Number
180040
Participating Start Date
12/6/2005
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06208
2222 BARDSTOWN RD.
LOUISVILLE, KY 40205
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/8/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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