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JEWISH HOSPITAL & ST. MARYS HEALTHCARE
DSH180040G UofL Health -- Louisville
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Covered Entity Details
Entity Name
UofL Health -- Louisville
Subdivision Name
MEDICAL CENTER NORTH EAST
Type
Disproportionate Share Hospital
340B ID
DSH180040G
Entity Address
2401 TERRA CROSSING BOULEVARD
LOUISVILLE, KY 40245
Medicare Provider Number
180040
Outpatient Facility Provider Number
Participating Start Date
10/8/2009
Last Recertification Date
9/13/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
JEWISH HOSPITAL & ST. MARYS HEALTHCARE
Pharmacy Address
DBA PHARMACY PLUS SPECIALTY
5111 COMMERCE CROSSINGS DRIVE
STE 120
LOUISVILLE, KY 40229
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Colleen Holton, Chief Financial Officer
(502) 587-4170
Contract Pharmacy Representative
Mark Milburn, VP
(502) 561-3900
Signed By Date
7/15/2014
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