Contract Pharmacy Details

MEIJER PHARMACY #184
DSH180143 SAINT JOSEPH EAST

Covered Entity Details

Entity Name

SAINT JOSEPH EAST

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180143

Entity Address

150 NORTH EAGLE CREEK DRIVE
LEXINGTON, KY 40509

Medicare Provider Number

180143

Participating Start Date

1/1/2008

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

MEIJER PHARMACY #184

Pharmacy Address

351 MEIJER WAY, SUITE 100
LEXINGTON, KY 40503

Pharmacy Comments

Contract Details

Approval Date

4/16/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/11/2016
Agreement registered in error

Contacts

Covered Entity Signing Official

Mendy Evans, VP Finance
(859) 313-1694

Contract Pharmacy Representative

Meijer
Jeff Romano, Hospital Programs
(616) 791-3171

Signed By Date

4/16/2013