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KENTUCKY CENTRAL FILL FACILITY, L-010
CAH181315-00 FORT LOGAN HOSPITAL
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Covered Entity Details
Entity Name
FORT LOGAN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181315-00
Entity Address
110 METKER TRAIL
STANFORD, KY 40484
Medicare Provider Number
181315
Participating Start Date
9/16/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CENTRAL FILL FACILITY, L-010
Pharmacy Address
5594 SHEPHERDSVILLE ROAD
LOUISVILLE, KY 40228-1012
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
10/9/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Ina Louise Glass, Administrator
(606) 365-4788
Contract Pharmacy Representative
Ephraim McDowell Health
Megan N Curtis, 340B Program Coordinator
(859) 239-1727
Signed By Date
7/15/2020
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