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KENTUCKY CVS PHARMACY, L.L.C.
DSH180080 BAPTIST HEALTH CORBIN
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Covered Entity Details
Entity Name
BAPTIST HEALTH CORBIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180080
Entity Address
1 TRILLIUM WAY
CORBIN, KY 40701
Medicare Provider Number
180080
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06341
533 SKIDMORE DRIVE
HARLAN, KY 40831
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Powers, COO
(606) 523-8626
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2023
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