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FRUTH PHARMACY AT FOODFAIR #102
DSH180009 KING'S DAUGHTERS MEDICAL CENTER
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Covered Entity Details
Entity Name
KING'S DAUGHTERS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180009
Entity Address
2201 LEXINGTON AVENUE
ASHLAND, KY 41101
Medicare Provider Number
180009
Participating Start Date
4/1/2006
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
FRUTH PHARMACY AT FOODFAIR #102
Pharmacy Address
630 N CAROLE MALONE BLVD
GRAYSON, KY 41143
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Whitlatch, CEO
(606) 408-4401
Contract Pharmacy Representative
Fruth Pharmacy
Andy Becker, VP Pharmacy
(304) 675-1612 Ext: 10117
Signed By Date
10/6/2020
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