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FRUTH PHARMACY OF OHIO, INC.
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
FRUTH PHARMACY OF OHIO, INC.
Pharmacy Address
FRUTH PHARMACY #26
1848 STATE ROUTE 141
IRONTON, OH 45638
Pharmacy Comments
Contract Details
Approval Date
10/26/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristie Whitlatch, CEO
(606) 408-4401
Contract Pharmacy Representative
Fruth Pharmacy
Tom Willoughby, Chief Financial Officer
(304) 675-1612 Ext: 163
Signed By Date
10/26/2016
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