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PYLES PHARMACY INC
DSH180149 TJ HEALTH COLUMBIA
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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
PYLES PHARMACY INC
Pharmacy Address
706 JAMESTOWN ST
DBA: CENTURY MEDICINES
COLUMBIA, KY 42728-1116
Pharmacy Comments
Contract Details
Approval Date
8/8/2011
Contract Begin Date
8/8/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
TIMOTHY MENTON, INTERIM CEO
(270) 374-4753
Contract Pharmacy Representative
Sheila Bryant, Pharmacy Manager
(270) 384-5874
Signed By Date
10/5/2011
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