Contract Pharmacy Details

RITE AID OF KENTUCKY, INC.
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HIGHLANDS ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180005

Entity Address

5000 KY RT 321
PRESTONSBURG, KY 41653

Medicare Provider Number

180005

Participating Start Date

9/9/2005

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

RITE AID OF KENTUCKY, INC.

Pharmacy Address

RITE AID #1607
103 GLYNNVIEW PLAZA
PRESTONSBURG, KY 41653

Pharmacy Comments

Contract Details

Approval Date

10/2/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/26/2018
Ownership change

Contacts

Covered Entity Signing Official

JACK BLACKWELL, CFO
(606) 886-8511

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

10/2/2014

340B Drug Pricing Program Database