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ST. MATTHEWS SPECIALTY PHARMACY
CAH181330-01 RUSSELL COUNTY HOSPITAL
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Covered Entity Details
Entity Name
RUSSELL COUNTY HOSPITAL
Subdivision Name
Family Practice Associates
Type
Critical Access Hospital
340B ID
CAH181330-01
Entity Address
124 DOWELL RD
RUSSELL SPRINGS, KY 42642-4278
Medicare Provider Number
181330
Outpatient Facility Provider Number
Participating Start Date
10/1/2016
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ST. MATTHEWS SPECIALTY PHARMACY
Pharmacy Address
DBA ST. MATTHEWS SPECIALTY PHARMACY
200 N HURSTBOURNE PKWY STE 176
LOUISVILLE, KY 40222
Pharmacy Comments
Contract Details
Approval Date
4/10/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Janie Landis, CFO
(270) 866-4753
Contract Pharmacy Representative
St. Matthews Specialty Pharmacy
Emily Blaiklock, PharmD
(502) 690-4462
Signed By Date
4/10/2018
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