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TOTAL PHARMACY CARE #3
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HIGHLANDS ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180005
Entity Address
5000 KY RT 321
PRESTONSBURG, KY 41653
Medicare Provider Number
180005
Participating Start Date
9/9/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
TOTAL PHARMACY CARE #3
Pharmacy Address
420 N LAKE DR
PRESTONSBURG, KY 41653-1230
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Harold C. Warman Jr., CEO
(606) 886-7602
Contract Pharmacy Representative
Total Pharmacy Care #3
Billy Rowe, Owner
(606) 433-0555
Signed By Date
10/16/2017
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