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BARDSTOWN PHARMACY SERVICE, LLC
DSH180012 Baptist Health Hardin
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Covered Entity Details
Entity Name
Baptist Health Hardin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180012
Entity Address
913 NORTH DIXIE AVENUE
ELIZABETHTOWN, KY 42701
Medicare Provider Number
180012
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
BARDSTOWN PHARMACY SERVICE, LLC
Pharmacy Address
D.B.A. CRUME DRUG STORE
111 W FLAGET ST
BARDSTOWN, KY 40004-1422
Pharmacy Comments
Contract Details
Approval Date
10/3/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/18/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Carrico, Chief Operating Officer
(270) 706-5321
Contract Pharmacy Representative
Bardstown Pharmacy Services, LLC
Gary Osborne, Owner
(502) 348-3938
Signed By Date
10/3/2017
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