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EPHRAIM MCDOWELL REGIONAL
CAH181315-00 FORT LOGAN HOSPITAL
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Covered Entity Details
Entity Name
FORT LOGAN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181315-00
Entity Address
110 METKER TRAIL
STANFORD, KY 40484
Medicare Provider Number
181315
Participating Start Date
9/16/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
EPHRAIM MCDOWELL REGIONAL
Pharmacy Address
MEDICAL CENTER OUTPATIENT
217 S 3RD ST
DANVILLE, KY 40422-1823
Pharmacy Comments
Contract Details
Approval Date
4/10/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ina Louise Glass, Administrator
(606) 365-4788
Contract Pharmacy Representative
Ephraim McDowell Health
Joan B Haltom, System Director of Pharmacy
(859) 239-1721
Signed By Date
4/10/2018
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