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RITE AID OF KENTUCKY, INC.
DSH180067 UNIVERSITY OF KENTUCKY
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Covered Entity Details
Entity Name
UNIVERSITY OF KENTUCKY
Subdivision Name
UK Chandler Hospital
Type
Disproportionate Share Hospital
340B ID
DSH180067
Entity Address
800 ROSE STREET
LEXINGTON, KY 40536
Medicare Provider Number
180067
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
RITE AID OF KENTUCKY, INC.
Pharmacy Address
RITE AID #3954
4101 TATES CREEK CTR DR ST156
LEXINGTON, KY 40517
Pharmacy Comments
Contract Details
Approval Date
4/9/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2018
Ownership change
Contacts
Covered Entity Signing Official
ANN SMITH, CHIEF ADMINISTRATIVE OFFICER
(859) 323-5470
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/9/2013
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