Contract Pharmacy Details

CLARK DRUGS
DSH180017 TJ SAMSON COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

TJ SAMSON COMMUNITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180017

Entity Address

1301 NORTH RACE STREET
GLASGOW, KY 42141

Medicare Provider Number

180017

Participating Start Date

7/1/2005

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

CLARK DRUGS

Pharmacy Address

CLARK DRUGS
500 MAIN ST
MUNFORDVILLE, KY 42765

Pharmacy Comments

Contract Details

Approval Date

6/20/2012

Contract Begin Date

6/20/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

BILL KINDRED, CEO
(270) 651-4159

Contract Pharmacy Representative

Clark Drugs
Alan Flener, President
(270) 524-3669

Signed By Date

6/8/2012