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KENTUCKY CVS PHARMACY, L.L.C.
DSH180103 Baptist Health Lexington
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Covered Entity Details
Entity Name
Baptist Health Lexington
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180103
Entity Address
1740 NICHOLASVILLE ROAD
LEXINGTON, KY 40503
Medicare Provider Number
180103
Participating Start Date
7/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06345
24 W LEXINGTON AVE
WINCHESTER, KY 40391
Pharmacy Comments
Contract Details
Approval Date
3/31/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christopher M. Roty, President
(859) 260-6104
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
3/31/2023
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