Covered Entity Details

CHC09959-15 GRACE COMMUNITY HEALTH CENTER, INC. (Active) - information as of 6/28/2025 12:22:40 AM

Main Details

Name

GRACE COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Corbin Educational Center SBHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-018740

340B ID

CHC09959-15

Grant Number

H80CS09959

Additional Details

Current Program Status

Active

Registration Date

1/6/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/17/2016

Last Recertification Date

2/27/2025

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

901 South Main Street
CORBIN, KY 40701-1123

Billing Address

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

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
KY	7100058700	1568625648

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC09959-00	Terminated	BPS-H80-007702	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Community Health Center, Inc	39 Cumberland Gap Plaza		Gray	KY
CHC09959-01	Active	BPS-H80-027205	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Health Manchester	85 Highway 80		Manchester	KY
CHC09959-02	Terminated	BPS-H80-011546	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Community Health Center, Inc. - Leslie County	5923 Highway 80		Wooton	KY
CHC09959-03	Terminated	BPS-H80-013435	GRACE COMMUNITY HEALTH CENTER, INC.	GCHC SBHC Goose Rock	364 Highway 1524		Manchester	KY
CHC09959-04	Terminated	BPS-H80-013302	GRACE COMMUNITY HEALTH CENTER, INC.	GCHC SBHC Clay Middle	239 Richmond Rd		Manchester	KY
CHC09959-05	Terminated	BPS-H80-013291	GRACE COMMUNITY HEALTH CENTER, INC.	Grace SBHC Hacker Elem	84 Hooker Rd		Manchester	KY
CHC09959-06	Terminated	BPS-H80-013065	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC School Based Health Big Creek	523 N. Highway 66		Oneida	KY
CHC09959-07	Terminated	BPS-H80-013250	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC School Based Health Paces Creek Elementary	1983 S. Highway 421		Manchester	KY
CHC09959-08	Active	BPS-H80-019070	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Health Women's Care	1019 Cumberland Falls Hwy	Ste D141	Corbin	KY
CHC09959-09	Active	BPS-H80-017263	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Corbin Elementary	710 W 8TH ST		CORBIN	KY
CHC09959-10	Terminated	BPS-H80-017272	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Clay County High School	415 CLAY COUNTY HIGH RD		MANCHESTER	KY
CHC09959-11	Active	BPS-H80-017271	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Corbin High School	1901 SNYDER ST		CORBIN	KY
CHC09959-12	Terminated	BPS-H80-017270	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Oneida Elementary	435 NEWFOUND RD		ONEIDA	KY
CHC09959-13	Terminated	BPS-H80-017269	GRACE COMMUNITY HEALTH CENTER, INC.	Grace SBH Burning Springs Elementary	9847 N. Hwy 421		Manchester	KY
CHC09959-14	Terminated	BPS-H80-017268	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Manchester Elementary	1908 N HIGHWAY 421		MANCHESTER	KY
CHC09959-15	Active	BPS-H80-018740	GRACE COMMUNITY HEALTH CENTER, INC.	Corbin Educational Center SBHC	901 South Main Street		CORBIN	KY
CHC09959-16	Active	BPS-H80-017265	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH W.B. Muncy Elementary	142 PIRATE DR		WOOTON	KY
CHC09959-17	Active	BPS-H80-024845	GRACE COMMUNITY HEALTH CENTER, INC.	Grace SBH Corbin Middle School	50 Ed Mcneel Dr		Corbin	KY
CHC09959-18	Active	BPS-H80-017262	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Corbin Primary	3551 5TH STREET RD		CORBIN	KY
CHC09959-19	Terminated	BPS-H80-017261	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Hayes Lewis Elementary School Based Health	Highway 699		YEADDISS	KY
CHC09959-20	Active	BPS-H80-017260	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Mountain View Elementary School	170 Bear Trl		Hyden	KY
CHC09959-21	Active	BPS-H80-017259	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Corbin Preschool	614 MASTER ST		CORBIN	KY
CHC09959-22	Terminated	BPS-H80-017258	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Corbin Intermediate	404 W. 17th Street		Corbin	KY
CHC09959-23	Active	BPS-H80-015489	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Bell Central School	9821 US Highway 25 E		Pineville	KY
CHC09959-24	Active	BPS-H80-015487	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Bell County High School	9824 US Highway 25E		Pineville	KY
CHC09959-25	Active	BPS-H80-015484	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Lone Jack School	101 Creech Hollow Road		Four Mile	KY
CHC09959-26	Active	BPS-H80-015480	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Right Fork School	5296 HIGHWAY 221		STONEY FORK	KY
CHC09959-27	Active	BPS-H80-015479	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Page School	239 PAGE SCHOOL RD		PINEVILLE	KY
CHC09959-28	Active	BPS-H80-015478	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Frakes School	29 Henderson Settlement Loop		Frakes	KY
CHC09959-29	Active	BPS-H80-015472	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Yellow Creek School	4840 W Cumberland Ave		MIDDLESBORO	KY
CHC09959-30	Active	BPS-H80-014695	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Community Health Center Administrative Offices	1019 Cumberland Falls Hwy	Ste B201	Corbin	KY
CHC09959-31	Terminated	BPS-H80-010646	GRACE COMMUNITY HEALTH CENTER, INC.	Mobile Dental Clinic	39 Cumberland Gap Plaza		Gray	KY
CHC09959-32	Active	BPS-H80-017266	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC SBH Stinnett Elementary School	12975 Highway 421		Hoskinston	KY
CHC09959-33	Active	BPS-H80-017448	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Pineville	313 Cherry Street		Pineville	KY
CHC09959-34	Terminated	BPS-H80-017447	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Bishop Street	121 Bishop St		Corbin	KY
CHC09959-35	Active	BPS-H80-018611	GRACE COMMUNITY HEALTH CENTER, INC.	Grace Community Health Center, Inc. - Hyden	21154 Highway 421		Hyden	KY
CHC09959-36	Terminated	BPS-H80-018919	GRACE COMMUNITY HEALTH CENTER, INC.	Grace CHC Falls Highway	1419 Cumberland Falls Highway		Corbin	KY
CHC09959-37	Active	BPS-H80-021765	Grace Community Health Center, Inc.	GCHC SBHC Girdler Elementary	5452 N. KY 11		Girdler	KY
CHC09959-38	Active	BPS-H80-021763	Grace Community Health Center, Inc.	GCHC- Appalachian Children's Home	1909 KY-3439		Barbourville	KY
CHC09959-39	Active	BPS-H80-021744	Grace Community Health Center, Inc.	Grace SBHC Central Elem	1000 Ky 3439		Barbourville	KY
CHC09959-40	Active	BPS-H80-021762	Grace Community Health Center, Inc.	Grace SBHC Lynn Camp Middle/High School	100 N KY 830		Corbin	KY
CHC09959-41	Active	BPS-H80-021764	Grace Community Health Center, Inc.	Knox County Area Technology Center	210 Wall St		Barbourville	KY
CHC09959-42	Active	BPS-H80-021766	Grace Community Health Center, Inc.	Grace SBHC Knox Central High School	100 Panther Way		Barbourville	KY
CHC09959-43	Active	BPS-H80-021746	Grace Community Health Center, Inc.	Grace SBHC Jesse D. Lay Elem	220 N Allison Ave		Barbourville	KY
CHC09959-44	Active	BPS-H80-021745	Grace Community Health Center, Inc.	GCHC SBHC Dewitt Elem	138 KY 718		Flat Lick	KY
CHC09959-45	Active	BPS-H80-021747	Grace Community Health Center, Inc.	Grace SBHC GR Hampton Elem	60 KY 3441		Barbourville	KY
CHC09959-46	Active	BPS-H80-021760	Grace Community Health Center, Inc.	GCHC SBHC Lynn Camp Elementary	366 N KY 830		Barbourville	KY
CHC09959-47	Active	BPS-H80-021748	Grace Community Health Center, Inc.	Grace SBHC Flat Lick Elem	100 KY 3085		Flat Lick	KY
CHC09959-48	Active	BPS-H80-021761	Grace Community Health Center, Inc.	Grace SBHC Knox Co Middle	311 N Main St		Barbourville	KY
CHC09959-49	Active	BPS-H80-024993	Grace Community Health Center, Inc.	Grace SBHC Corbin School of Innovation	200 W 8th St		Corbin	KY
CHC09959-50	Active	BPS-H80-028278	Grace Community Health Center, Inc.	Grace SBHC Leslie Co High School	25 Eagle Ln		Hyden	KY
CHC09959-51	Active	BPS-H80-028277	Grace Community Health Center, Inc.	Grace Health Mountain View	272 London Mountain View Dr		London	KY
CHC09959-52	Terminated	BPS-H80-029982	Grace Community Health Center, Inc.	Grace Health Pediatrics	120 North Commonwealth Avenue STE 1,2,3,&4		Corbin	KY
CHC09959-53	Active	BPS-H80-030293	Grace Community Health Center, Inc.	Grace SBHC Middlesboro Middle School	4400 W Cumberland Ave		Middlesboro	KY
CHC09959-54	Active	BPS-H80-030296	Grace Community Health Center, Inc.	Grace SBHC Middlesboro Elementary School	3400 Cumberland Ave		Middlesboro	KY
CHC09959-55	Active	BPS-H80-030324	Grace Community Health Center, Inc.	Grace SBHC Middlesboro High School	4404 W Cumberland Ave		Middlesboro	KY
CHC09959-56	Active	BPS-H80-031948	Grace Community Health Center, Inc.	Grace Health Levi Center Clinic	934 S Laurel Rd Ste 1		London	KY
CHC09959-57	Active	BPS-H80-032616	Grace Community Health Center, Inc.	Grace Health UC Clinic	49 W Sycamore St		Williamsburg	KY
CHC09959-58	Active	BPS-H80-034320	Grace Community Health Center, Inc.	Grace Health SBHC Hayes Lewis Elementary	10130 Cutshin Rd		Yeaddiss	KY
CHC09959-59	Active	BPS-H80-035936	GRACE COMMUNITY HEALTH CENTER	Grace Health SBHC Pineville Independent School	401 W. Virginia Avenue		Pineville	KY
CHC09959-60	Terminated	BPS-H80-036539	GRACE COMMUNITY HEALTH CENTER	Grace Health Corbin Pediatrics	57 Summitt Drive		Corbin	KY
CHC09959-61	Active	BPS-H80-036637	GRACE COMMUNITY HEALTH CENTER	Grace Health Medical Campus	14662 N US Highway 25 E		Corbin	KY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC09959-01	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
CHC09959-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2021	01/01/2024
CHC09959-01	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC09959-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2021	01/01/2024
CHC09959-01	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CHC09959-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2021	01/01/2024
CHC09959-01	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2023
CHC09959-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2021	01/01/2024
CHC09959-01	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CHC09959-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2021	01/01/2024
CHC09959-01	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CHC09959-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2021	01/01/2024
CHC09959-01	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CHC09959-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2021	01/01/2024
CHC09959-01	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CHC09959-00	CAREMARK PUERTO RICO SPECIALTY PHARMACY,	CAREMARK PUERTO RICO SPECIALTY PHARMACY	6020 AVE ROBERTO SANCHEZ VILELLA	CAROLINA	PR	00982	01/01/2021	11/17/2020
CHC09959-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2021	01/01/2024
CHC09959-01	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2023
CHC09959-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2021	01/01/2024
CHC09959-01	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2023
CHC09959-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2021	01/01/2024
CHC09959-01	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2023
CHC09959-00	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	04/01/2021	01/01/2024
CHC09959-00	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/01/2021	01/01/2024
CHC09959-01	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	07/01/2023	10/16/2023
CHC09959-01	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	07/01/2023	10/16/2023
CHC09959-00	CORUM FAMILY PHARMACY		1668 SOUTH HIGHWAY 421	MANCHESTER	KY	40962	04/01/2015	04/25/2016
CHC09959-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2021	01/01/2024
CHC09959-01	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2023
CHC09959-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2021	01/01/2024
CHC09959-01	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
CHC09959-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2021	01/01/2024
CHC09959-01	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2023
CHC09959-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2018	01/01/2024
CHC09959-01	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2023
CHC09959-00	FAMILY DRUG CENTER	415 RICHMOND RD UNIT B		MANCHESTER	KY	40962-1212	11/15/2010	12/18/2018
CHC09959-00	FAMILY DRUG CENTER #3	214 BRIDGE STREET		MANCHESTER	KY	40962	04/01/2011	08/01/2015
CHC09959-01	FAMILY DRUG CENTER #3	214 BRIDGE STREET		MANCHESTER	KY	40962	11/15/2010	08/01/2015
CHC09959-00	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	01/01/2020	10/09/2022
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06342	2104 NORTH MAIN ST	LONDON	KY	40741	04/01/2020	01/01/2024
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10155	102 VILLAGE LANE	HAZARD	KY	41701	04/01/2020	01/01/2024
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06343	30 S KY HIGHWAY 15	HAZARD	KY	41701	04/01/2020	02/21/2023
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06341	533 SKIDMORE DRIVE	HARLAN	KY	40831	04/01/2020	01/01/2024
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06346	409 EAST MAIN STREET	RICHMOND	KY	40475	07/01/2022	01/01/2024
CHC09959-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06941	118 EAST NEW CIRCLE RD.	LEXINGTON	KY	40505	01/01/2023	01/01/2024
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10155	102 VILLAGE LANE	HAZARD	KY	41701	07/01/2023
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06341	533 SKIDMORE DRIVE	HARLAN	KY	40831	07/01/2023
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06343	30 S KY HIGHWAY 15	HAZARD	KY	41701	07/01/2023	02/28/2023
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06342	2104 NORTH MAIN ST	LONDON	KY	40741	07/01/2023
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06346	409 EAST MAIN STREET	RICHMOND	KY	40475	07/01/2023
CHC09959-01	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06941	118 EAST NEW CIRCLE RD.	LEXINGTON	KY	40505	07/01/2023
CHC09959-00	KING PHARMACY, INC	KING PHARMACY, HYDEN	22320 MAIN ST KING PHARMACY HYDEN	HYDEN	KY	41749-8571	04/01/2014	12/26/2017
CHC09959-00	KNOX PROFESSIONAL PHARMACY INC	511 KNOX ST		BARBOURVILLE	KY	40906-1330	06/01/2011	08/01/2018
CHC09959-00	KROGER	14889 NORTH US HWY. 25E	SUITE A	CORBIN	KY	40701	06/14/2011	01/01/2024
CHC09959-01	KROGER	14889 NORTH US HWY. 25E	SUITE A	CORBIN	KY	40701	07/01/2023
CHC09959-00	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	01/01/2023	01/01/2024
CHC09959-01	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	07/01/2023
CHC09959-00	KROGER PHARMACY #409	1732 WEST HWY 192		LONDON	KY	40741	07/01/2019	01/01/2024
CHC09959-01	KROGER PHARMACY #409	1732 WEST HWY 192		LONDON	KY	40741	07/01/2023
CHC09959-00	KROGER PHARMACY L-719	1019 CUMBERLAND FALLS HWY.		CORBIN	KY	40701	12/28/2011	01/01/2024
CHC09959-01	KROGER PHARMACY L-719	1019 CUMBERLAND FALLS HWY.		CORBIN	KY	40701	07/01/2023
CHC09959-00	MEDICINE SHOPPE OF HYDEN	22044 MAIN ST	PO BOX 455	HYDEN	KY	41749-8568	07/01/2014	01/01/2024
CHC09959-01	MEDICINE SHOPPE OF HYDEN	22044 MAIN ST	PO BOX 455	HYDEN	KY	41749-8568	07/01/2023
CHC09959-00	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/01/2021	01/01/2024
CHC09959-01	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2023
CHC09959-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2021	01/01/2024
CHC09959-01	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2023
CHC09959-00	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2021	01/01/2024
CHC09959-01	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/01/2023
CHC09959-00	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/01/2021	01/01/2024
CHC09959-00	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	01/01/2021	01/01/2024
CHC09959-00	OPTUM PHARMACY 705, LLC	11142 RENNER BLVD		LENEXA	KS	66219	01/01/2021	06/07/2021
CHC09959-00	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	01/01/2021	01/01/2024
CHC09959-01	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/01/2023
CHC09959-01	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/01/2023
CHC09959-01	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2023
CHC09959-00	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2021	01/01/2024
CHC09959-01	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2023
CHC09959-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2022	01/01/2024
CHC09959-01	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2023
CHC09959-00	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2018	10/01/2022
CHC09959-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2021	01/01/2024
CHC09959-01	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CHC09959-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2021	01/01/2024
CHC09959-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2021	01/01/2024
CHC09959-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2021	01/01/2024
CHC09959-01	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CHC09959-01	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2023
CHC09959-01	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CHC09959-00	RITE AID OF KENTUCKY, INC.	RITE AID #3916	560 MANCHESTER SQUARE	MANCHESTER	KY	40962	10/05/2012	01/19/2018
CHC09959-00	RITE AID OF KENTUCKY, INC.	RITE AID #3919	297 TERRELL LANE	BARBOURVILLE	KY	40906	10/05/2012	01/19/2018
CHC09959-00	RITE AID OF KENTUCKY, INC.	RITE AID #2439	21287 HIGHWAY 421	HYDEN	KY	41749	01/01/2014	01/19/2018
CHC09959-00	RITE AID OF KENTUCKY, INC.	RITE AID #1656	1320 CUMBERLAND FALLS HIGHWAY	CORBIN	KY	40701	07/01/2016	01/19/2018
CHC09959-00	RITE AID OF KENTUCKY, INC.	RITE AID #1657	116 N. PINE STREET	PINEVILLE	KY	40977	07/01/2016	01/19/2018
CHC09959-00	SAV-RITE PHARMACY, LLC	1150 MASTER ST		CORBIN	KY	40701	04/01/2015	06/08/2016
CHC09959-00	SENDERRA RX PHARMACY	SENDERRA RX PARTNERS, LLC	3712 E PLANO PKWY STE 200	PLANO	TX	75074	10/01/2020	01/01/2024
CHC09959-01	SENDERRA RX PHARMACY	SENDERRA RX PARTNERS, LLC	3712 E PLANO PKWY STE 200	PLANO	TX	75074	07/01/2023
CHC09959-00	STANLEY AND TURNER DRUG COMPANY	DBA STANLEY PHARMACY COMPOUNDING CENTER	2413 W BEEBE CAPPS EXPY	SEARCY	AR	72143	07/01/2019	09/17/2019
CHC09959-00	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02404	417 E EMORY RD	POWELL	TN	37849-3518	04/01/2020	01/01/2024
CHC09959-00	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06365	101 N. CHARLES G SEIVERS BLVD.	CLINTON	TN	37716	04/01/2020	01/01/2024
CHC09959-01	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06365	101 N. CHARLES G SEIVERS BLVD.	CLINTON	TN	37716	07/01/2023
CHC09959-01	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02404	417 E EMORY RD	POWELL	TN	37849-3518	07/01/2023
CHC09959-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2018	01/01/2024
CHC09959-01	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-1048	589 HIGHWAY WEST 92		WILLIAMSBURG	KY	40769	07/01/2018	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-1048	589 HIGHWAY WEST 92		WILLIAMSBURG	KY	40769	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-1113	1851 WEST HWY 192		LONDON	KY	40741	07/01/2018	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-1113	1851 WEST HWY 192		LONDON	KY	40741	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-1189	301 PARKWAY PLAZA		BARBOURVILLE	KY	40906	07/01/2018	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-1189	301 PARKWAY PLAZA		BARBOURVILLE	KY	40906	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-1259	60 SOUTH STEWART ROAD		CORBIN	KY	40701	07/01/2018	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-1259	60 SOUTH STEWART ROAD		CORBIN	KY	40701	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2020	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/01/2023
CHC09959-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2018	01/01/2024
CHC09959-01	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2023
CHC09959-00	WALGREEN CO	DBA: WALGREENS #13034	528 W TENNESSEE AVE	PINEVILLE	KY	40977	04/01/2018	01/01/2024
CHC09959-00	WALGREEN CO	DBA: WALGREENS #12152	1775 HIGHWAY 192 W	LONDON	KY	40741	04/01/2018	01/01/2024
CHC09959-01	WALGREEN CO	DBA: WALGREENS #13034	528 W TENNESSEE AVE	PINEVILLE	KY	40977	07/01/2023
CHC09959-01	WALGREEN CO	DBA: WALGREENS #12152	1775 HIGHWAY 192 W	LONDON	KY	40741	07/01/2023
CHC09959-00	WALGREEN CO.	DBA: WALGREENS #12111	14659 N US HIGHWAY 25 E STE C	CORBIN	KY	40701	04/01/2018	01/01/2024
CHC09959-00	WALGREEN CO.	DBA: WALGREENS #11884	1121 S. US HWY 25E	BARBOURVILLE	KY	40906	04/01/2018	01/01/2024
CHC09959-00	WALGREEN CO.	WALGREENS #18301	1320 CUMBERLAND FALLS HWY	CORBIN	KY	40701	01/24/2018	01/01/2024
CHC09959-00	WALGREEN CO.	WALGREENS #19658	560 MANCHESTER SQUARE SHPG CTR	MANCHESTER	KY	40962	01/24/2018	01/01/2024
CHC09959-00	WALGREEN CO.	RITE AID #01657	116 N PINE ST	PINEVILLE	KY	40977	01/24/2018	05/14/2019
CHC09959-00	WALGREEN CO.	WALGREENS #17162	21287 HIGHWAY 421 PO BOX 1665	HYDEN	KY	41749	01/24/2018	01/01/2024
CHC09959-00	WALGREEN CO.	RITE AID #03919	297 TERRELL LN	BARBOURVILLE	KY	40906	01/24/2018	09/28/2018
CHC09959-00	WALGREEN CO.	RITE AID #03932	839 S MAIN ST	LONDON	KY	40741	04/01/2019	05/22/2019
CHC09959-00	WALGREEN CO.	DBA: WALGREENS #18950	248 S. MAIN ST	JELLICO	TN	37762	01/01/2023	03/07/2023
CHC09959-01	WALGREEN CO.	DBA: WALGREENS #11884	1121 S. US HWY 25E	BARBOURVILLE	KY	40906	07/01/2023
CHC09959-01	WALGREEN CO.	WALGREENS #17162	21287 HIGHWAY 421 PO BOX 1665	HYDEN	KY	41749	07/01/2023
CHC09959-01	WALGREEN CO.	WALGREENS #19658	560 MANCHESTER SQUARE SHPG CTR	MANCHESTER	KY	40962	07/01/2023	03/26/2025
CHC09959-01	WALGREEN CO.	WALGREENS #18301	1320 CUMBERLAND FALLS HWY	CORBIN	KY	40701	07/01/2023	03/17/2025
CHC09959-01	WALGREEN CO.	DBA: WALGREENS #12111	14659 N US HIGHWAY 25 E STE C	CORBIN	KY	40701	07/01/2023
CHC09959-01	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC09959-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2018	01/01/2024
CHC09959-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2018	01/01/2024
CHC09959-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2018	01/01/2024
CHC09959-00	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2018	10/01/2021
CHC09959-01	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2023
CHC09959-01	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2023
CHC09959-01	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2023
CHC09959-01	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CHC09959-01	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/31/2024 3:24:22 PM	2/27/2025 11:42:27 AM	2/27/2025 11:42 AM
Details	Last Recertification Date	Update	Recertification	2/1/2023 2:13:25 PM	1/31/2024 3:24:22 PM	1/31/2024 3:24 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 2:44:45 PM	2/1/2023 2:13:25 PM	2/1/2023 2:13 PM
Contacts	Primary Contact	Update	Profile Change Request	Whittaker, David Casey Interim Pharmacy Director Grace Health 6063124145	Whittaker, David Casey Pharmacy Director Grace Health 6063124145	1/30/2023 10:27 AM
Contacts	Primary Contact	Update	PC Change Request	Cheek, Rebecca Clinical Pharmacist Grace Community Health Center 6065269005	Whittaker, David Casey Interim Pharmacy Director Grace Health 6063124145	11/16/2022 7:10 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 9:08:58 AM	1/31/2022 2:44:45 PM	1/31/2022 2:44 PM
Medicaid Billing	NPI: State	Update	Recertification		KY	2/4/2021 9:08 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 9:49:49 AM	2/4/2021 9:08:58 AM	2/4/2021 9:08 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 1:54:42 PM	1/28/2020 9:49:49 AM	1/28/2020 9:49 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		2/11/2019 6:28 AM
Details	Entity Subname	Update	Change Request	Grace CHC SBH Corbin Educational Center	Corbin Educational Center SBHC	2/11/2019 6:28 AM
Details	Last Recertification Date	Update	Recertification	2/13/2018 7:43:46 AM	1/29/2019 1:54:42 PM	1/29/2019 1:54 PM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/13/2018 7:43:46 AM	2/13/2018 7:43 AM
Contacts	Authorizing Official	Update		Stanley, Michael Chief Executive Officer 6065269005	Stanley, Michael W Chief Executive Officer Grace Community Health Center, Inc. 6065269005	10/5/2017 2:51 PM
Contacts	Primary Contact	Update		Cheek, Rebecca Clinical Pharmacist 6065269005	Cheek, Rebecca Clinical Pharmacist Grace Community Health Center 6065269005	9/20/2017 1:28 PM
Contacts	Authorizing Official	Insert			Stanley, Michael Chief Executive Officer 6065269005	8/4/2017 11:46 AM
Contacts	Signed By	Insert			Stanley, Michael Chief Executive Officer 6065269005	8/4/2017 11:46 AM
Contacts	Primary Contact	Update		Cheek, Rebecca Clinical Pharmacist 6065269005	Cheek, Rebecca Clinical Pharmacist 6065269005	8/4/2017 11:46 AM
Addresses	Main Address	Insert			901 South Main Street CORBIN, KY 40701-1123	8/3/2017 4:13 PM
Addresses	Billing Address	Insert			Grace Community Health Center 1019 Cumberland Falls Hwy Suite B201 Corbin, KY 40701-2735	8/3/2017 4:13 PM
Contacts	Primary Contact	Insert			Cheek, Rebecca Clinical Pharmacist 6065269005	4/13/2017 2:09 PM
Details	Last Recertification Date	Update			2/8/2017 12:00:00 AM	2/8/2017 1:00 PM
Dates	Participating Approval Date	Update			2/17/2016 12:00:00 AM	2/17/2016 2:33 PM
Details	State	Update		Pending	Active	2/17/2016 2:33 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/17/2016 2:33 PM
Details	340B ID	Update		ONLINE_REG_56696	CHC09959-15	2/9/2016 3:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/6/2016 11:40 AM
Medicaid Billing	Medicaid: Number	Insert			7100058700	1/6/2016 11:40 AM
Medicaid Billing	Medicaid: State	Insert			KY	1/6/2016 11:40 AM
Medicaid Billing	NPI: Number	Insert			1568625648	1/6/2016 11:40 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_56696	1/6/2016 11:40 AM
Details	Last Recertification Date	Insert				1/6/2016 11:40 AM
Details	Grant Number	Insert			H80CS09959	1/6/2016 11:40 AM
Details	340B ID	Insert			ONLINE_REG	1/6/2016 11:40 AM
Details	Is Authorizing Official EHB Data	Insert			False	1/6/2016 11:40 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/6/2016 11:40 AM
Details	Medicare Provider Number	Insert				1/6/2016 11:40 AM
Details	Entity Name	Insert			GRACE COMMUNITY HEALTH CENTER, INC.	1/6/2016 11:40 AM
Details	Program Code	Insert			CH	1/6/2016 11:40 AM
Details	Entity Subname	Insert			Grace CHC SBH Corbin Educational Center	1/6/2016 11:40 AM
Dates	Participating Approval Date	Insert				1/6/2016 11:40 AM
Details	State	Insert			Pending	1/6/2016 11:40 AM
Dates	Registration Date	Insert			1/6/2016 12:00:00 AM	1/6/2016 11:40 AM
Dates	Signed By Date	Insert			1/6/2016 12:00:00 AM	1/6/2016 11:40 AM
Dates	Start Date	Insert				1/6/2016 11:40 AM
Terminations	Termination Comments	Insert				1/6/2016 11:40 AM
Terminations	Termination Date	Insert				1/6/2016 11:40 AM
Terminations	Termination Effective Date	Insert				1/6/2016 11:40 AM
Terminations	Termination Reason	Insert				1/6/2016 11:40 AM

340B Drug Pricing Program Database