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KENTUCKY CVS PHARMACY, L.L.C.
DSH180012 Baptist Health Hardin
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Covered Entity Details
Entity Name
Baptist Health Hardin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180012
Entity Address
913 NORTH DIXIE AVENUE
ELIZABETHTOWN, KY 42701
Medicare Provider Number
180012
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06338
101 EAST BROADWAY
CAMPBELLSVILLE, KY 42718
Pharmacy Comments
Contract Details
Approval Date
4/5/2023
Contract Begin Date
4/10/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Carrico, Chief Operating Officer
(270) 706-5321
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/5/2023
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