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MIDWAY PHARMACY CANEYVILLE
DSH180070 Owensboro Health Twin Lakes Regional Medical Center, Inc
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Covered Entity Details
Entity Name
Owensboro Health Twin Lakes Regional Medical Center, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180070
Entity Address
910 WALLACE AVENUE
LEITCHFIELD, KY 42754
Medicare Provider Number
180070
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MIDWAY PHARMACY CANEYVILLE
Pharmacy Address
408 EAST MAPLE STREET
PO BOX 607
CANEYVILLE, KY 42721
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Arndell, CFO
(270) 259-9509
Contract Pharmacy Representative
Midway Pharmacy
Trevor Ray, PIC
(270) 259-8400
Signed By Date
4/17/2017
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