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STOVALL'S PRESCRIPTION SHOP
CAH181324-01 THE MEDICAL CENTER AT SCOTTSVILLE
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Covered Entity Details
Entity Name
THE MEDICAL CENTER AT SCOTTSVILLE
Subdivision Name
Scottsville Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH181324-01
Entity Address
466 Burnley Rd
Scottsville, KY 42164
Medicare Provider Number
181324
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
STOVALL'S PRESCRIPTION SHOP
Pharmacy Address
202 S COURT ST
PO BOX 217
SCOTTSVILLE, KY 42164-1263
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Wade R. Stone, Executive Vice President
(270) 745-1504
Contract Pharmacy Representative
Stovalls Prescription Shop Inc
Rob Madon, Pharmacist
(270) 237-5402
Signed By Date
4/18/2023
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