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EASTRIDGE-PHELPS PHARMACY, LLC
CAH181325-00 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
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Covered Entity Details
Entity Name
JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181325-00
Entity Address
290 Industrial Park Road
GREENSBURG, KY 42743
Medicare Provider Number
181325
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
EASTRIDGE-PHELPS PHARMACY, LLC
Pharmacy Address
DBA EASTRIDGE-PHELPS PHARMACY GREENSBURG
460 COMMERCE DR
GREENSBURG, KY 42743
Pharmacy Comments
Contract Details
Approval Date
3/23/2012
Contract Begin Date
4/12/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(270) 932-9696 Ext: 22
Contract Pharmacy Representative
Chad Phelps, Owner
(270) 299-2333
Signed By Date
4/5/2012
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