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MIDTOWN PHARMACY EXPRESS
CAH181323-00 Ohio County Hospital
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Covered Entity Details
Entity Name
Ohio County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181323-00
Entity Address
1211 Old Main Street
Hartford, KY 42347-1619
Medicare Provider Number
181323
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MIDTOWN PHARMACY EXPRESS
Pharmacy Address
500 N MAIN ST
BEAVER DAM, KY 42320
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Juanita K. Park, President
(270) 298-5495
Contract Pharmacy Representative
John Fuller, President
(270) 274-9224
Signed By Date
7/14/2014
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