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STOVALL'S PRESCRIPTION SHOP
CAH181324-00 THE MEDICAL CENTER AT SCOTTSVILLE
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Covered Entity Details
Entity Name
THE MEDICAL CENTER AT SCOTTSVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181324-00
Entity Address
456 BURNLEY ROAD
SCOTTSVILLE, KY 42164
Medicare Provider Number
181324
Participating Start Date
4/1/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
STOVALL'S PRESCRIPTION SHOP
Pharmacy Address
202 S COURT ST
PO BOX 217
SCOTTSVILLE, KY 42164-1263
Pharmacy Comments
Contract Details
Approval Date
10/2/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ERIC HAGAN, VICE PRESIDENT/ADMINISTRATOR
(270) 622-2800 Ext: 2821
Contract Pharmacy Representative
Ann Keown, RPH, VP
(270) 237-5402
Signed By Date
10/2/2013
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