Contract Pharmacy Details

KING'S DAUGHTERS
DSH180009 KING'S DAUGHTERS MEDICAL CENTER

Covered Entity Details

Entity Name

KING'S DAUGHTERS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180009

Entity Address

2201 LEXINGTON AVENUE
ASHLAND, KY 41101

Medicare Provider Number

180009

Participating Start Date

4/1/2006

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

KING'S DAUGHTERS

Pharmacy Address

2230 LEXINGTON AVE
ASHLAND, KY 41101

Pharmacy Comments

Contract Details

Approval Date

6/14/2007

Contract Begin Date

6/14/2007

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/19/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

Paul McDowell, CFO
(606) 408-4404

Contract Pharmacy Representative

Stacy Patrick, VP, Chief Nursing Officer
(606) 324-0092

Signed By Date

6/14/2007

340B Drug Pricing Program Database