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HAROLD CLINIC PHARMACY
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HIGHLANDS ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180005
Entity Address
5000 KY RT 321
PRESTONSBURG, KY 41653
Medicare Provider Number
180005
Participating Start Date
9/9/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HAROLD CLINIC PHARMACY
Pharmacy Address
159 KY 680 EAST
HAROLD, KY 41635
Pharmacy Comments
Contract Details
Approval Date
1/21/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maria Braman, Chief Medical Officer
(406) 465-8506
Contract Pharmacy Representative
McDowell Professional Pharmacy
Steven Dawson, President/Pharmacist
(606) 377-1088
Signed By Date
1/21/2025
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