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ST. MATTHEWS COMMUNITY PHARMACY
CAH181309-00 CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181309-00
Entity Address
187 WOLFORD AVENUE
LIBERTY, KY 42539
Medicare Provider Number
181309
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ST. MATTHEWS COMMUNITY PHARMACY
Pharmacy Address
3922 WILLIS AVENUE
LOUISVILLE, KY 40207
Pharmacy Comments
Contract Details
Approval Date
4/20/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(606) 787-6275 Ext: 601
Contract Pharmacy Representative
St Matthews Specialty Pharmacy
Jill Rhodes, Owner
(859) 552-3334
Signed By Date
4/20/2016
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