Contract Pharmacy Details

RITE AID OF KENTUCKY, INC.
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

RITE AID OF KENTUCKY, INC.

Pharmacy Address

RITE AID #1743
100 SOUTH CAROL MALONE BLVD.
GRAYSON, KY 41143

Pharmacy Comments

Contract Details

Approval Date

11/20/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/1/2018
Ownership change

Contacts

Covered Entity Signing Official

Paul McDowell, CFO
(606) 408-4404

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

10/5/2012

340B Drug Pricing Program Database