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BENTON DISCOUNT PHARMACY
CAH181327-00 MARSHALL COUNTY HOSPITAL
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Covered Entity Details
Entity Name
MARSHALL COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181327-00
Entity Address
615 OLD SYMSONIA RD
BENTON, KY 42025
Medicare Provider Number
181327
Participating Start Date
7/1/2018
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
BENTON DISCOUNT PHARMACY
Pharmacy Address
DBA/DRAFFENVILLE PHARMACY
153 US HIGHWAY 68 E
BENTON, KY 42025-7123
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Fuqua, CEO
(270) 527-4850
Contract Pharmacy Representative
Benton Discount Pharmacy
Kirk Dripps, Manager
(270) 527-1409
Signed By Date
7/12/2021
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