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MEDICINE SHOPPE OF HYDEN
CAH181316-00 ARH MARY BRECKINRIDGE HEALTH SERVICES, INC. DBA MARY BRECKINRIDGE ARH HOSPITAL
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Covered Entity Details
Entity Name
ARH MARY BRECKINRIDGE HEALTH SERVICES, INC. DBA MARY BRECKINRIDGE ARH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181316-00
Entity Address
130 KATE IRELAND DRIVE
HYDEN, KY 41749
Medicare Provider Number
181316
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE OF HYDEN
Pharmacy Address
22044 MAIN ST
PO BOX 455
HYDEN, KY 41749-8568
Pharmacy Comments
Contract Details
Approval Date
4/6/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Medicine Shoppe
Keith Stewart, Manager
(606) 672-8705
Signed By Date
4/6/2015
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