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HOUCHENS EXPRESS PHARMACY LLC
DSH180013 THE MEDICAL CENTER - BOWLING GREEN
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Covered Entity Details
Entity Name
THE MEDICAL CENTER - BOWLING GREEN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180013
Entity Address
250 PARK STREET
BOWLING GREEN, KY 42101
Medicare Provider Number
180013
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HOUCHENS EXPRESS PHARMACY LLC
Pharmacy Address
DBA SHELDON'S EXPRESS PHARMACY
843 FAIRVIEW AVE STE A1
BOWLING GREEN, KY 42101-4914
Pharmacy Comments
03/10/2010 - NAME AND ADDRESS CHANGED FROM NATION'S MEDICINE, 830 FAIRVIEW AVE.
Contract Details
Approval Date
10/11/2012
Contract Begin Date
10/11/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CONNIE SMITH, CEO
(270) 745-1262
Contract Pharmacy Representative
Steve Sheldon, CEO
(270) 392-0821
Signed By Date
9/13/2012
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