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CERTACARE 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
CERTACARE INC
Pharmacy Address
937 CAMPBELLSVILLE ROAD
SUITE 907
COLUMBIA, KY 42728
Pharmacy Comments
Contract Details
Approval Date
3/14/2013
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
Getwell Pharmacy of ColumbiaKY DBA CertaCare
Kevin Miller, CEO
(270) 385-9139
Signed By Date
1/29/2013
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