340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LAKE CUMBERLAND PHARMACY, LLC
DSH180149 TJ HEALTH COLUMBIA
Print
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
LAKE CUMBERLAND PHARMACY, LLC
Pharmacy Address
LAKE CUMBERLAND PHARMACY
2431 LAKEWAY DR STE C
RUSSELL SPRINGS, KY 42642
Pharmacy Comments
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
David Rasmussen, CEO
(270) 384-4753 Ext: 154
Contract Pharmacy Representative
Russell County Hospital
Jonathan Grider, Managing Member
(270) 858-6400
Signed By Date
1/21/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session