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BIOSCRIP INFUSION SERVICES, LLC
DSH180069 TUG VALLEY ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TUG VALLEY ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180069
Entity Address
260 HOSPITAL DRIVE
SOUTH WILLIAMSON, KY 41503
Medicare Provider Number
180069
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BIOSCRIP INFUSION SERVICES, LLC
Pharmacy Address
DBA BIOSCRIP INFUSION SERVICES
4401 MACCORKLE AVE SE
CHARLESTON, WV 25304
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Angie Christian, General Manager
(304) 414-3660
Signed By Date
7/14/2015
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