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JANE TODD CRAWFORD MEMORIAL HOSPITAL, IN
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
JANE TODD CRAWFORD MEMORIAL HOSPITAL, IN
Pharmacy Address
DBA JANE TODD PHARMACY
310 INDUSTRIAL PARK RD STE 2
GREENSBURG, KY 42743
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(270) 932-9696 Ext: 22
Contract Pharmacy Representative
LaGene Sexton, 340B Coordinator
(270) 805-1281
Signed By Date
1/14/2015
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