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KROGER PHARMACY L-369
DSH180087 TAYLOR COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
TAYLOR COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180087
Entity Address
1700 OLD LEBANON ROAD
CAMPBELLSVILLE, KY 42718
Medicare Provider Number
180087
Participating Start Date
10/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-369
Pharmacy Address
399 CAMPBELLSVILLE BYPASS STE 100
CAMPBELLSVILLE, KY 42718
Pharmacy Comments
12/13/2011 updated address (was US 68 and Highway 210)
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William Martin Snapp, CFO
(270) 465-3561
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/12/2023
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