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OHIO CVS STORES, L.L.C.
DSH180009 KING'S DAUGHTERS MEDICAL CENTER
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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
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06349
1109 IRONTON HILLS DR.
IRONTON, OH 45638
Pharmacy Comments
Contract Details
Approval Date
1/12/2012
Contract Begin Date
1/12/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul McDowell, CFO
(606) 408-4404
Contract Pharmacy Representative
CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
12/16/2011
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