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PARKWAY PHARMACY
DSH180002 WHITESBURG ARH HOSPITAL
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Covered Entity Details
Entity Name
WHITESBURG ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180002
Entity Address
240 HOSPITAL ROAD
WHITESBURG, KY 41858
Medicare Provider Number
180002
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PARKWAY PHARMACY
Pharmacy Address
2354 HIGHWAY 15
PARKWAY PHARMACY
WHITESBURG, KY 41858-7413
Pharmacy Comments
Contract Details
Approval Date
4/6/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/27/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Harlan Medical Center
Ernie Watts, Owner/Operator
(606) 589-0003
Signed By Date
4/6/2015
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