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GRANT COUNTY DRUGS
CAH181311-00 ST ELIZABETH HEALTHCARE GRANT COUNTY
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Covered Entity Details
Entity Name
ST ELIZABETH HEALTHCARE GRANT COUNTY
Subdivision Name
ST ELIZABETH GRANT COUNTY
Type
Critical Access Hospital
340B ID
CAH181311-00
Entity Address
238 BARNES RD
WILLIAMSTOWN, KY 41097
Medicare Provider Number
181311
Participating Start Date
10/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GRANT COUNTY DRUGS
Pharmacy Address
24 S MAIN ST
PO BOX 106
DRY RIDGE, KY 41035
Pharmacy Comments
Contract Details
Approval Date
5/23/2012
Contract Begin Date
5/23/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
GARREN COLVIN, SENIOR VICE PRESIDENT, CFO
(859) 655-1642
Contract Pharmacy Representative
Jason Wallace, Owner
(859) 428-3784
Signed By Date
5/14/2012
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