Contract Pharmacy Details

COLUMBIA PHARMACY
DSH180149 TJ HEALTH COLUMBIA

Covered Entity Details

Entity Name

TJ HEALTH COLUMBIA

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180149

Entity Address

901 Wellness Way
COLUMBIA, KY 42728

Medicare Provider Number

180149

Participating Start Date

4/1/2019

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

COLUMBIA PHARMACY

Pharmacy Address

803 BURKESVILLE STREET
COLUMBIA, KY 42728-1655

Pharmacy Comments

Contract Details

Approval Date

7/26/2011

Contract Begin Date

7/26/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/17/2015
Pharmacy closed

Contacts

Covered Entity Signing Official

TIMOTHY MENTON, INTERIM CEO
(270) 374-4753

Contract Pharmacy Representative

Patrick Huff, Vice President
(270) 384-2117

Signed By Date

10/5/2011