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KENTUCKY CVS PHARMACY, L.L.C.
CAH181323-00 Ohio County Hospital
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Covered Entity Details
Entity Name
Ohio County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181323-00
Entity Address
1211 Old Main Street
Hartford, KY 42347-1619
Medicare Provider Number
181323
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07940
1221 FREDERICA ST.
OWENSBORO, KY 42301
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shellie Dube Shouse, CFO
(270) 504-4050
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/18/2022
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