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APOTHECARE PHARMACY VINE GROVE
RRC180012-00 BAPTIST HEALTH HARDIN
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Covered Entity Details
Entity Name
BAPTIST HEALTH HARDIN
Subdivision Name
Type
Rural Referral Center
340B ID
RRC180012-00
Entity Address
913 NORTH DIXIE AVENUE
ELIZABETHTOWN, KY 42701
Medicare Provider Number
180012
Participating Start Date
1/1/2025
Last Recertification Date
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
APOTHECARE PHARMACY VINE GROVE
Pharmacy Address
107 CRUTCHER ST
VINE GROVE, KY 40175
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Dennis Johnson, CEO
(270) 706-1006
Contract Pharmacy Representative
ApotheCARE Pharmacy IV Vine Grove
David Tabb, Pharmacist
(270) 877-5111
Signed By Date
7/15/2016
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