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LYON DRUG STORE
CAH181320-00 Livingston Hospital and Healthcare Services, Inc.
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Covered Entity Details
Entity Name
Livingston Hospital and Healthcare Services, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181320-00
Entity Address
131 Hospital Drive
Salem, KY 42078
Medicare Provider Number
181320
Participating Start Date
7/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
LYON DRUG STORE
Pharmacy Address
201 W MAIN ST
PO BOX 490
EDDYVILLE, KY 42038-7752
Pharmacy Comments
Contract Details
Approval Date
4/24/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Snodgrass, CEO
(270) 988-7235
Contract Pharmacy Representative
Lyon Drug Store
Edwin Nickell, President
(270) 388-2236
Signed By Date
4/24/2014
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