340B Drug Pricing Program Database


CHC09959-15 GRACE COMMUNITY HEALTH CENTER, INC. (Active) - information as of 6/6/2025 4:28:36 AM

Main Details
GRACE COMMUNITY HEALTH CENTER, INC.
Corbin Educational Center SBHC
HRSA-Funded Health Center
BPS-H80-018740
CHC09959-15
H80CS09959


Additional Details
Active
1/6/2016
4/1/2016
2/17/2016
2/27/2025

Contacts

Grace Community Health Center, Inc.
Michael W Stanley, Chief Executive Officer
(606) 526-9005

Grace Health
David Casey Whittaker, Pharmacy Director
(606) 312-4145

Addresses

901 South Main Street
CORBIN, KY 40701-1123

Grace Community Health Center
1019 Cumberland Falls Hwy
Suite B201
Corbin, KY 40701-2735


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
KY71000587001568625648
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC09959-00TerminatedBPS-H80-007702GRACE COMMUNITY HEALTH CENTER, INC.Grace Community Health Center, Inc39 Cumberland Gap Plaza GrayKY
CHC09959-01ActiveBPS-H80-027205GRACE COMMUNITY HEALTH CENTER, INC.Grace Health Manchester85 Highway 80 ManchesterKY
CHC09959-02TerminatedBPS-H80-011546GRACE COMMUNITY HEALTH CENTER, INC.Grace Community Health Center, Inc. - Leslie County5923 Highway 80 WootonKY
CHC09959-03TerminatedBPS-H80-013435GRACE COMMUNITY HEALTH CENTER, INC.GCHC SBHC Goose Rock364 Highway 1524 ManchesterKY
CHC09959-04TerminatedBPS-H80-013302GRACE COMMUNITY HEALTH CENTER, INC.GCHC SBHC Clay Middle239 Richmond Rd ManchesterKY
CHC09959-05TerminatedBPS-H80-013291GRACE COMMUNITY HEALTH CENTER, INC.Grace SBHC Hacker Elem84 Hooker Rd ManchesterKY
CHC09959-06TerminatedBPS-H80-013065GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC School Based Health Big Creek523 N. Highway 66 OneidaKY
CHC09959-07TerminatedBPS-H80-013250GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC School Based Health Paces Creek Elementary1983 S. Highway 421 ManchesterKY
CHC09959-08ActiveBPS-H80-019070GRACE COMMUNITY HEALTH CENTER, INC.Grace Health Women's Care1019 Cumberland Falls HwySte D141CorbinKY
CHC09959-09ActiveBPS-H80-017263GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Corbin Elementary710 W 8TH ST CORBINKY
CHC09959-10TerminatedBPS-H80-017272GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Clay County High School415 CLAY COUNTY HIGH RD MANCHESTERKY
CHC09959-11ActiveBPS-H80-017271GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Corbin High School1901 SNYDER ST CORBINKY
CHC09959-12TerminatedBPS-H80-017270GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Oneida Elementary435 NEWFOUND RD ONEIDAKY
CHC09959-13TerminatedBPS-H80-017269GRACE COMMUNITY HEALTH CENTER, INC.Grace SBH Burning Springs Elementary9847 N. Hwy 421 ManchesterKY
CHC09959-14TerminatedBPS-H80-017268GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Manchester Elementary1908 N HIGHWAY 421 MANCHESTERKY
CHC09959-15ActiveBPS-H80-018740GRACE COMMUNITY HEALTH CENTER, INC.Corbin Educational Center SBHC901 South Main Street CORBINKY
CHC09959-16ActiveBPS-H80-017265GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH W.B. Muncy Elementary142 PIRATE DR WOOTONKY
CHC09959-17ActiveBPS-H80-024845GRACE COMMUNITY HEALTH CENTER, INC.Grace SBH Corbin Middle School50 Ed Mcneel Dr CorbinKY
CHC09959-18ActiveBPS-H80-017262GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Corbin Primary3551 5TH STREET RD CORBINKY
CHC09959-19TerminatedBPS-H80-017261GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Hayes Lewis Elementary School Based HealthHighway 699 YEADDISSKY
CHC09959-20ActiveBPS-H80-017260GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Mountain View Elementary School170 Bear Trl HydenKY
CHC09959-21ActiveBPS-H80-017259GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Corbin Preschool614 MASTER ST CORBINKY
CHC09959-22TerminatedBPS-H80-017258GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Corbin Intermediate404 W. 17th Street CorbinKY
CHC09959-23ActiveBPS-H80-015489GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Bell Central School9821 US Highway 25 E PinevilleKY
CHC09959-24ActiveBPS-H80-015487GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Bell County High School9824 US Highway 25E PinevilleKY
CHC09959-25ActiveBPS-H80-015484GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Lone Jack School101 Creech Hollow Road Four MileKY
CHC09959-26ActiveBPS-H80-015480GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Right Fork School5296 HIGHWAY 221 STONEY FORKKY
CHC09959-27ActiveBPS-H80-015479GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Page School239 PAGE SCHOOL RD PINEVILLEKY
CHC09959-28ActiveBPS-H80-015478GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Frakes School29 Henderson Settlement Loop FrakesKY
CHC09959-29ActiveBPS-H80-015472GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Yellow Creek School4840 W Cumberland Ave MIDDLESBOROKY
CHC09959-30ActiveBPS-H80-014695GRACE COMMUNITY HEALTH CENTER, INC.Grace Community Health Center Administrative Offices1019 Cumberland Falls HwySte B201CorbinKY
CHC09959-31TerminatedBPS-H80-010646GRACE COMMUNITY HEALTH CENTER, INC.Mobile Dental Clinic39 Cumberland Gap Plaza GrayKY
CHC09959-32ActiveBPS-H80-017266GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC SBH Stinnett Elementary School12975 Highway 421 HoskinstonKY
CHC09959-33ActiveBPS-H80-017448GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Pineville313 Cherry Street PinevilleKY
CHC09959-34TerminatedBPS-H80-017447GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Bishop Street121 Bishop St CorbinKY
CHC09959-35ActiveBPS-H80-018611GRACE COMMUNITY HEALTH CENTER, INC.Grace Community Health Center, Inc. - Hyden21154 Highway 421 HydenKY
CHC09959-36TerminatedBPS-H80-018919GRACE COMMUNITY HEALTH CENTER, INC.Grace CHC Falls Highway1419 Cumberland Falls Highway CorbinKY
CHC09959-37ActiveBPS-H80-021765Grace Community Health Center, Inc.GCHC SBHC Girdler Elementary5452 N. KY 11 GirdlerKY
CHC09959-38ActiveBPS-H80-021763Grace Community Health Center, Inc.GCHC- Appalachian Children's Home1909 KY-3439 BarbourvilleKY
CHC09959-39ActiveBPS-H80-021744Grace Community Health Center, Inc.Grace SBHC Central Elem1000 Ky 3439 BarbourvilleKY
CHC09959-40ActiveBPS-H80-021762Grace Community Health Center, Inc.Grace SBHC Lynn Camp Middle/High School100 N KY 830 CorbinKY
CHC09959-41ActiveBPS-H80-021764Grace Community Health Center, Inc.Knox County Area Technology Center210 Wall St BarbourvilleKY
CHC09959-42ActiveBPS-H80-021766Grace Community Health Center, Inc.Grace SBHC Knox Central High School100 Panther Way BarbourvilleKY
CHC09959-43ActiveBPS-H80-021746Grace Community Health Center, Inc.Grace SBHC Jesse D. Lay Elem220 N Allison Ave BarbourvilleKY
CHC09959-44ActiveBPS-H80-021745Grace Community Health Center, Inc.GCHC SBHC Dewitt Elem138 KY 718 Flat LickKY
CHC09959-45ActiveBPS-H80-021747Grace Community Health Center, Inc.Grace SBHC GR Hampton Elem60 KY 3441 BarbourvilleKY
CHC09959-46ActiveBPS-H80-021760Grace Community Health Center, Inc.GCHC SBHC Lynn Camp Elementary366 N KY 830 BarbourvilleKY
CHC09959-47ActiveBPS-H80-021748Grace Community Health Center, Inc.Grace SBHC Flat Lick Elem100 KY 3085 Flat LickKY
CHC09959-48ActiveBPS-H80-021761Grace Community Health Center, Inc.Grace SBHC Knox Co Middle311 N Main St BarbourvilleKY
CHC09959-49ActiveBPS-H80-024993Grace Community Health Center, Inc.Grace SBHC Corbin School of Innovation200 W 8th St CorbinKY
CHC09959-50ActiveBPS-H80-028278Grace Community Health Center, Inc.Grace SBHC Leslie Co High School25 Eagle Ln HydenKY
CHC09959-51ActiveBPS-H80-028277Grace Community Health Center, Inc.Grace Health Mountain View272 London Mountain View Dr LondonKY
CHC09959-52TerminatedBPS-H80-029982Grace Community Health Center, Inc.Grace Health Pediatrics120 North Commonwealth Avenue STE 1,2,3,&4 CorbinKY
CHC09959-53ActiveBPS-H80-030293Grace Community Health Center, Inc.Grace SBHC Middlesboro Middle School4400 W Cumberland Ave MiddlesboroKY
CHC09959-54ActiveBPS-H80-030296Grace Community Health Center, Inc.Grace SBHC Middlesboro Elementary School3400 Cumberland Ave MiddlesboroKY
CHC09959-55ActiveBPS-H80-030324Grace Community Health Center, Inc.Grace SBHC Middlesboro High School4404 W Cumberland Ave MiddlesboroKY
CHC09959-56ActiveBPS-H80-031948Grace Community Health Center, Inc.Grace Health Levi Center Clinic934 S Laurel Rd Ste 1 LondonKY
CHC09959-57ActiveBPS-H80-032616Grace Community Health Center, Inc.Grace Health UC Clinic49 W Sycamore St WilliamsburgKY
CHC09959-58ActiveBPS-H80-034320Grace Community Health Center, Inc.Grace Health SBHC Hayes Lewis Elementary10130 Cutshin Rd YeaddissKY
CHC09959-59ActiveBPS-H80-035936GRACE COMMUNITY HEALTH CENTERGrace Health SBHC Pineville Independent School401 W. Virginia Avenue PinevilleKY
CHC09959-60TerminatedBPS-H80-036539GRACE COMMUNITY HEALTH CENTERGrace Health Corbin Pediatrics57 Summitt Drive CorbinKY
CHC09959-61ActiveBPS-H80-036637GRACE COMMUNITY HEALTH CENTERGrace Health Medical Campus14662 N US Highway 25 E CorbinKY
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC09959-01ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280907/01/2024  
CHC09959-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2021 01/01/2024
CHC09959-01CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2023  
CHC09959-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2021 01/01/2024
CHC09959-01CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2023  
CHC09959-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2021 01/01/2024
CHC09959-01CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2023  
CHC09959-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2021 01/01/2024
CHC09959-01CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2023  
CHC09959-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2021 01/01/2024
CHC09959-01CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2023  
CHC09959-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2021 01/01/2024
CHC09959-01CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2023  
CHC09959-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2021 01/01/2024
CHC09959-01CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2023  
CHC09959-00CAREMARK PUERTO RICO SPECIALTY PHARMACY,CAREMARK PUERTO RICO SPECIALTY PHARMACY 6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINAPR0098201/01/2021 11/17/2020
CHC09959-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813301/01/2021 01/01/2024
CHC09959-01CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2023  
CHC09959-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237401/01/2021 01/01/2024
CHC09959-01CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2023  
CHC09959-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2021 01/01/2024
CHC09959-01CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2023  
CHC09959-00CENTERWELL PHARMACY, INC.10737 MARKS WAY
MIRAMARFL3302504/01/2021 01/01/2024
CHC09959-00CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506904/01/2021 01/01/2024
CHC09959-01CENTERWELL PHARMACY, INC.10737 MARKS WAY
MIRAMARFL3302507/01/2023 10/16/2023
CHC09959-01CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506907/01/2023 10/16/2023
CHC09959-00CORUM FAMILY PHARMACY  1668 SOUTH HIGHWAY 421
MANCHESTERKY4096204/01/2015 04/25/2016
CHC09959-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021 01/01/2024
CHC09959-01CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2023  
CHC09959-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021 01/01/2024
CHC09959-01CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2023  
CHC09959-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2021 01/01/2024
CHC09959-01CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2023  
CHC09959-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/01/2018 01/01/2024
CHC09959-01CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2023  
CHC09959-00FAMILY DRUG CENTER415 RICHMOND RD UNIT B
MANCHESTERKY40962-121211/15/2010 12/18/2018
CHC09959-00FAMILY DRUG CENTER #3214 BRIDGE STREET
MANCHESTERKY4096204/01/2011 08/01/2015
CHC09959-01FAMILY DRUG CENTER #3214 BRIDGE STREET
MANCHESTERKY4096211/15/2010 08/01/2015
CHC09959-00KENTUCKY CENTRAL FILL FACILITY, L-0105594 SHEPHERDSVILLE ROAD
LOUISVILLEKY40228-101201/01/2020 10/09/2022
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06342 2104 NORTH MAIN ST
LONDONKY4074104/01/2020 01/01/2024
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10155 102 VILLAGE LANE
HAZARDKY4170104/01/2020 01/01/2024
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06343 30 S KY HIGHWAY 15
HAZARDKY4170104/01/2020 02/21/2023
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06341 533 SKIDMORE DRIVE
HARLANKY4083104/01/2020 01/01/2024
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06346 409 EAST MAIN STREET
RICHMONDKY4047507/01/2022 01/01/2024
CHC09959-00KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06941 118 EAST NEW CIRCLE RD.
LEXINGTONKY4050501/01/2023 01/01/2024
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10155 102 VILLAGE LANE
HAZARDKY4170107/01/2023  
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06341 533 SKIDMORE DRIVE
HARLANKY4083107/01/2023  
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06343 30 S KY HIGHWAY 15
HAZARDKY4170107/01/2023 02/28/2023
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06342 2104 NORTH MAIN ST
LONDONKY4074107/01/2023  
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06346 409 EAST MAIN STREET
RICHMONDKY4047507/01/2023  
CHC09959-01KENTUCKY CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06941 118 EAST NEW CIRCLE RD.
LEXINGTONKY4050507/01/2023  
CHC09959-00KING PHARMACY, INCKING PHARMACY, HYDEN 22320 MAIN ST
KING PHARMACY HYDEN
HYDENKY41749-857104/01/2014 12/26/2017
CHC09959-00KNOX PROFESSIONAL PHARMACY INC511 KNOX ST
BARBOURVILLEKY40906-133006/01/2011 08/01/2018
CHC09959-00KROGER14889 NORTH US HWY. 25E SUITE A
CORBINKY4070106/14/2011 01/01/2024
CHC09959-01KROGER14889 NORTH US HWY. 25E SUITE A
CORBINKY4070107/01/2023  
CHC09959-00Kroger PharmacyJeffersonville Central Fill Facility 301 Logistics Ave
Suite 200
JeffersonvilleIN4713001/01/2023 01/01/2024
CHC09959-01Kroger PharmacyJeffersonville Central Fill Facility 301 Logistics Ave
Suite 200
JeffersonvilleIN4713007/01/2023  
CHC09959-00KROGER PHARMACY #4091732 WEST HWY 192
LONDONKY4074107/01/2019 01/01/2024
CHC09959-01KROGER PHARMACY #4091732 WEST HWY 192
LONDONKY4074107/01/2023  
CHC09959-00KROGER PHARMACY L-7191019 CUMBERLAND FALLS HWY.
CORBINKY4070112/28/2011 01/01/2024
CHC09959-01KROGER PHARMACY L-7191019 CUMBERLAND FALLS HWY.
CORBINKY4070107/01/2023  
CHC09959-00MEDICINE SHOPPE OF HYDEN22044 MAIN ST PO BOX 455
HYDENKY41749-856807/01/2014 01/01/2024
CHC09959-01MEDICINE SHOPPE OF HYDEN22044 MAIN ST PO BOX 455
HYDENKY41749-856807/01/2023  
CHC09959-00OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/01/2021 01/01/2024
CHC09959-01OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276507/01/2023  
CHC09959-00OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/01/2021 01/01/2024
CHC09959-01OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2023  
CHC09959-00OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/01/2021 01/01/2024
CHC09959-01OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824907/01/2023  
CHC09959-00OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729801/01/2021 01/01/2024
CHC09959-00OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265501/01/2021 01/01/2024
CHC09959-00OPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621901/01/2021 06/07/2021
CHC09959-00OPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970501/01/2021 01/01/2024
CHC09959-01OPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970507/01/2023  
CHC09959-01OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265507/01/2023  
CHC09959-01OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2023  
CHC09959-00OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/01/2021 01/01/2024
CHC09959-01OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2023  
CHC09959-00OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/01/2022 01/01/2024
CHC09959-01OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2023  
CHC09959-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999204/01/2018 10/01/2022
CHC09959-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2021 01/01/2024
CHC09959-01PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2023  
CHC09959-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681301/01/2021 01/01/2024
CHC09959-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2021 01/01/2024
CHC09959-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2021 01/01/2024
CHC09959-01PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
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CHC09959-01Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/31/2024 3:24:22 PM2/27/2025 11:42:27 AM2/27/2025 11:42 AM
DetailsLast Recertification DateUpdateRecertification2/1/2023 2:13:25 PM1/31/2024 3:24:22 PM1/31/2024 3:24 PM
DetailsLast Recertification DateUpdateRecertification1/31/2022 2:44:45 PM2/1/2023 2:13:25 PM2/1/2023 2:13 PM
ContactsPrimary ContactUpdateProfile Change RequestWhittaker, David Casey Interim Pharmacy Director Grace Health 6063124145Whittaker, David Casey Pharmacy Director Grace Health 60631241451/30/2023 10:27 AM
ContactsPrimary ContactUpdatePC Change RequestCheek, Rebecca Clinical Pharmacist Grace Community Health Center 6065269005Whittaker, David Casey Interim Pharmacy Director Grace Health 606312414511/16/2022 7:10 AM
DetailsLast Recertification DateUpdateRecertification2/4/2021 9:08:58 AM1/31/2022 2:44:45 PM1/31/2022 2:44 PM
Medicaid BillingNPI: StateUpdateRecertification KY2/4/2021 9:08 AM
DetailsLast Recertification DateUpdateRecertification1/28/2020 9:49:49 AM2/4/2021 9:08:58 AM2/4/2021 9:08 AM
DetailsLast Recertification DateUpdateRecertification1/29/2019 1:54:42 PM1/28/2020 9:49:49 AM1/28/2020 9:49 AM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 2/11/2019 6:28 AM
DetailsEntity SubnameUpdateChange RequestGrace CHC SBH Corbin Educational CenterCorbin Educational Center SBHC2/11/2019 6:28 AM
DetailsLast Recertification DateUpdateRecertification2/13/2018 7:43:46 AM1/29/2019 1:54:42 PM1/29/2019 1:54 PM
DetailsLast Recertification DateUpdateRecertification2/8/2017 12:00:00 AM2/13/2018 7:43:46 AM2/13/2018 7:43 AM
ContactsAuthorizing OfficialUpdate Stanley, Michael Chief Executive Officer 6065269005Stanley, Michael W Chief Executive Officer Grace Community Health Center, Inc. 606526900510/5/2017 2:51 PM
ContactsPrimary ContactUpdate Cheek, Rebecca Clinical Pharmacist 6065269005Cheek, Rebecca Clinical Pharmacist Grace Community Health Center 60652690059/20/2017 1:28 PM
ContactsAuthorizing OfficialInsert  Stanley, Michael Chief Executive Officer 60652690058/4/2017 11:46 AM
ContactsSigned ByInsert  Stanley, Michael Chief Executive Officer 60652690058/4/2017 11:46 AM
ContactsPrimary ContactUpdate Cheek, Rebecca Clinical Pharmacist 6065269005Cheek, Rebecca Clinical Pharmacist 60652690058/4/2017 11:46 AM
AddressesMain AddressInsert   901 South Main Street CORBIN, KY 40701-11238/3/2017 4:13 PM
AddressesBilling AddressInsert  Grace Community Health Center 1019 Cumberland Falls Hwy Suite B201 Corbin, KY 40701-27358/3/2017 4:13 PM
ContactsPrimary ContactInsert  Cheek, Rebecca Clinical Pharmacist 60652690054/13/2017 2:09 PM
DetailsLast Recertification DateUpdate  2/8/2017 12:00:00 AM2/8/2017 1:00 PM
DatesParticipating Approval DateUpdate  2/17/2016 12:00:00 AM2/17/2016 2:33 PM
DetailsStateUpdate PendingActive2/17/2016 2:33 PM
DatesStart DateUpdate  4/1/2016 12:00:00 AM2/17/2016 2:33 PM
Details340B IDUpdate ONLINE_REG_56696CHC09959-152/9/2016 3:36 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/6/2016 11:40 AM
Medicaid BillingMedicaid: NumberInsert  71000587001/6/2016 11:40 AM
Medicaid BillingMedicaid: StateInsert  KY1/6/2016 11:40 AM
Medicaid BillingNPI: NumberInsert  15686256481/6/2016 11:40 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_566961/6/2016 11:40 AM
DetailsLast Recertification DateInsert   1/6/2016 11:40 AM
DetailsGrant NumberInsert  H80CS099591/6/2016 11:40 AM
Details340B IDInsert  ONLINE_REG1/6/2016 11:40 AM
DetailsIs Authorizing Official EHB DataInsert  False1/6/2016 11:40 AM
DatesLast Date That 340B Drugs PurchasedInsert   1/6/2016 11:40 AM
DetailsMedicare Provider NumberInsert   1/6/2016 11:40 AM
DetailsEntity NameInsert  GRACE COMMUNITY HEALTH CENTER, INC.1/6/2016 11:40 AM
DetailsProgram CodeInsert  CH1/6/2016 11:40 AM
DetailsEntity SubnameInsert  Grace CHC SBH Corbin Educational Center1/6/2016 11:40 AM
DatesParticipating Approval DateInsert   1/6/2016 11:40 AM
DetailsStateInsert  Pending1/6/2016 11:40 AM
DatesRegistration DateInsert  1/6/2016 12:00:00 AM1/6/2016 11:40 AM
DatesSigned By DateInsert  1/6/2016 12:00:00 AM1/6/2016 11:40 AM
DatesStart DateInsert   1/6/2016 11:40 AM
TerminationsTermination CommentsInsert   1/6/2016 11:40 AM
TerminationsTermination DateInsert   1/6/2016 11:40 AM
TerminationsTermination Effective DateInsert   1/6/2016 11:40 AM
TerminationsTermination ReasonInsert   1/6/2016 11:40 AM