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WILLIAMS BROS HEALTH CARE PHARMACY
DSH150061 DAVIESS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
DAVIESS COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150061
Entity Address
1314 E. WALNUT STREET
WASHINGTON, IN 47501
Medicare Provider Number
150061
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WILLIAMS BROS HEALTH CARE PHARMACY
Pharmacy Address
10 WILLIAMS BROS. DR.
WASHINGTON, IN 47501-4535
Pharmacy Comments
Contract Details
Approval Date
6/29/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Catherine E. Keck, Chief Financial Officer
(812) 254-2760 Ext: 1103
Contract Pharmacy Representative
WIlliams Brothers
Mark Williams, Owner
(812) 254-8731
Signed By Date
6/29/2016
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