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NORTH PARK PHARMACY INC
CAH181312-02 NEW HORIZON MEDICAL CENTER
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Covered Entity Details
Entity Name
NEW HORIZON MEDICAL CENTER
Subdivision Name
NEW HORIZON HEALTH SYSTEMS, INC.
Type
Critical Access Hospital
340B ID
CAH181312-02
Entity Address
330 ROLAND AVENUE
OWENTON, KY 40359
Medicare Provider Number
181312
Outpatient Facility Provider Number
Participating Start Date
9/30/2010
Last Recertification Date
9/8/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
NORTH PARK PHARMACY INC
Pharmacy Address
327 NORTH MAIN
OWENTON, KY 40359
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
12/29/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/22/2010
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