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BAPTIST HEALTH SHARED SERVICES PHARMACY
DSH180080 BAPTIST HEALTH CORBIN
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Covered Entity Details
Entity Name
BAPTIST HEALTH CORBIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180080
Entity Address
1 TRILLIUM WAY
CORBIN, KY 40701
Medicare Provider Number
180080
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
BAPTIST HEALTH SHARED SERVICES PHARMACY
Pharmacy Address
1051 NEW MOODY LN STE 1400
LA GRANGE, KY 40031
Pharmacy Comments
Contract Details
Approval Date
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Bailey, President
(606) 523-8626
Contract Pharmacy Representative
baptist health
jordan marcus propst, director, central pharmacy
(864) 490-7827
Signed By Date
4/4/2024
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