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KENTUCKY CVS PHARMACY, L.L.C.
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
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06422
704 US 31W BYP
BOWLING GREEN, KY 42101
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CONNIE SMITH, CEO
(270) 745-1262
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
7/12/2013
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