Contract Pharmacy Details

RITE AID OF KENTUCKY, INC.
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HAZARD ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180029

Entity Address

100 MEDICAL CENTER DRIVE
HAZARD, KY 41701

Medicare Provider Number

180029

Participating Start Date

10/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

RITE AID OF KENTUCKY, INC.

Pharmacy Address

RITE AID #2439
21287 HIGHWAY 421
HYDEN, KY 41749

Pharmacy Comments

Contract Details

Approval Date

10/9/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Maria Braman, Chief Medical Officer
(406) 465-8506

Contract Pharmacy Representative

Walgreens
Allene Stewart, Analyst, 340B Client Relationship
(847) 315-4442

Signed By Date

10/9/2023

340B Drug Pricing Program Database