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ST MATTHEWS COMMUNITY PHARMACY
CAH181325-00 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
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Covered Entity Details
Entity Name
JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181325-00
Entity Address
290 Industrial Park Road
GREENSBURG, KY 42743
Medicare Provider Number
181325
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ST MATTHEWS COMMUNITY PHARMACY
Pharmacy Address
200 N HURSTBOURNE PKWY STE 174
LOUISVILLE, KY 40222
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard John Hendershot, CFO
(270) 932-9696 Ext: 25
Contract Pharmacy Representative
St. Matthews
Jonathon Grider, Pharmacist
(270) 585-2221
Signed By Date
4/11/2022
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