Contract Pharmacy Details

FAMILY DRUG CENTER #3
DSH180043 AdventHealth Manchester

Covered Entity Details

Entity Name

AdventHealth Manchester

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180043

Entity Address

210 MARIE LANGDON DRIVE
MANCHESTER, KY 40962

Medicare Provider Number

180043

Participating Start Date

10/1/2017

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

FAMILY DRUG CENTER #3

Pharmacy Address

214 BRIDGE STREET
MANCHESTER, KY 40962

Pharmacy Comments

Contract Details

Approval Date

8/3/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/10/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Steven Miller, VP Finance/CFO
(606) 598-1035

Contract Pharmacy Representative

Bob Sparkman, Owner
(606) 598-6736

Signed By Date

8/3/2017