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WIGGINS DRUGS LIMITED
CAH181323-06 Ohio County Hospital
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Covered Entity Details
Entity Name
Ohio County Hospital
Subdivision Name
Ohio County Family Care-Beaver Dam
Type
Critical Access Hospital
340B ID
CAH181323-06
Entity Address
1313 North Main Street
Beaver Dam, KY 42320
Medicare Provider Number
181323
Outpatient Facility Provider Number
Participating Start Date
7/1/2014
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WIGGINS DRUGS LIMITED
Pharmacy Address
1014 S MAIN ST
HARTFORD, KY 42347-1830
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shellie Dube Shouse, CFO
(270) 504-4050
Contract Pharmacy Representative
Ohio County Hospital
Barry Anthony Ward, Pharmacy Director
(270) 298-5177
Signed By Date
10/15/2020
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