340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LAKE CUMBERLAND PHARMACY, LLC
CAH181330-00 RUSSELL COUNTY HOSPITAL
Print
Covered Entity Details
Entity Name
RUSSELL COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181330-00
Entity Address
153 DOWELL ROAD
RUSSELL SPRINGS, KY 42642
Medicare Provider Number
181330
Participating Start Date
7/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
LAKE CUMBERLAND PHARMACY, LLC
Pharmacy Address
LAKE CUMBERLAND PHARMACY
2431 LAKEWAY DR STE C
RUSSELL SPRINGS, KY 42642
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
1/27/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Joseph Branco, CEO
(270) 866-4141 Ext: 526
Contract Pharmacy Representative
Lake Cumberland Pharmacy
Johnathan NMN Grider, Pharmacist
(270) 858-6400
Signed By Date
1/18/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session