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THOMPSON DISCOUNT DRUG
DSH180011B SAINT JOSEPH HEALTH SYSTEM
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Covered Entity Details
Entity Name
SAINT JOSEPH HEALTH SYSTEM
Subdivision Name
Saint Joseph Hematology Oncology
Type
Disproportionate Share Hospital
340B ID
DSH180011B
Entity Address
165 London Mountain View Drive
London, KY 40741
Medicare Provider Number
180011
Outpatient Facility Provider Number
Participating Start Date
1/1/2012
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
THOMPSON DISCOUNT DRUG
Pharmacy Address
810 E 4TH ST
LONDON, KY 40741-1428
Pharmacy Comments
Contract Details
Approval Date
8/30/2012
Contract Begin Date
8/30/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Brock, Chief Financial Officer
(606) 330-6000 Ext: 6016
Contract Pharmacy Representative
Britt Thompson, Owner
(606) 878-7713
Signed By Date
8/24/2012
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