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HOMETOWN PHARMACY OF CYNTHIANA
DSH180079 HARRISON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HARRISON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180079
Entity Address
1210 KY HIGHWAY 36 E
CYNTHIANA, KY 41031
Medicare Provider Number
180079
Participating Start Date
9/9/2005
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY OF CYNTHIANA
Pharmacy Address
1134 US HIGHWAY 27 SOUTH
CYNTHIANA, KY 41031-4103
Pharmacy Comments
Contract Details
Approval Date
4/2/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JIM SPEARS, CFO
(859) 235-3502
Contract Pharmacy Representative
Michael Ingram, Owner
(859) 234-5600
Signed By Date
4/2/2013
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