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JEWISH HOSPITAL & ST. MARYS HEALTHCARE I
DSH180143A SAINT JOSEPH EAST
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Covered Entity Details
Entity Name
SAINT JOSEPH EAST
Subdivision Name
Saint Joseph East Hemoc
Type
Disproportionate Share Hospital
340B ID
DSH180143A
Entity Address
3470 Blazer Parkway
Lexington, KY 40509
Medicare Provider Number
180143
Outpatient Facility Provider Number
Participating Start Date
4/1/2013
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
JEWISH HOSPITAL & ST. MARYS HEALTHCARE I
Pharmacy Address
DBA PHARMACY PLUS SPECIALTY
5111 COMMERCE CROSSINGS DRIVE STE 120
LOUISVILLE, KY 40229
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/4/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Mendy Evans, VP Finance
(859) 313-1694
Contract Pharmacy Representative
Jim Hurley, Director
(502) 561-3900
Signed By Date
7/7/2015
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