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JEWISH HOSPITAL & ST. MARYS HEALTHCARE
DSH180040H JEWISH HOSPITAL AND ST MARY'S HEALTHCARE (JHSMH)
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Covered Entity Details
Entity Name
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE (JHSMH)
Subdivision Name
CANCER AND BLOOD SPECIALISTS, A SERVICE OF JEWISH HOSPITAL AND SAINT MARY'S HEALTHCARE
Type
Disproportionate Share Hospital
340B ID
DSH180040H
Entity Address
1460 BLUEGRASS AVE
LOUISVILLE, KY 40215
Medicare Provider Number
180040
Outpatient Facility Provider Number
Participating Start Date
10/8/2009
Last Recertification Date
8/19/2016
Entity Termination Date
10/1/2017
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
10/1/2017
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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