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KENTUCKY CVS PHARMACY, L.L.C.
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
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02332
101 WEST SHOWALTER DRIVE
GEORGETOWN, KY 40324
Pharmacy Comments
Contract Details
Approval Date
7/5/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANN SMITH, CHIEF ADMINISTRATIVE OFFICER
(859) 323-5470
Contract Pharmacy Representative
West Virginia CVS Pharmacy, LLC
John R. Zevzavadjian, Vice President, Payer Relations
(401) 770-5503
Signed By Date
7/5/2013
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