Covered Entity Details

CHC24692-09 MOUNTAIN COMPREHENSIVE CARE CENTER, INC. (Active) - information as of 6/1/2025 4:51:09 AM

Main Details

Name

MOUNTAIN COMPREHENSIVE CARE CENTER, INC.

Subdivision Name

HomePlace Clinic for Children and Families

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032157

340B ID

CHC24692-09

Grant Number

H80CS24692

Additional Details

Current Program Status

Active

Registration Date

4/15/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/21/2021

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Mountain Comprehensive Care Center
Rachel Willoughby, Program Director
(606) 886-4319

Primary Contact

Mountain Comprehensive Care Center
Kristi Nicole McCoy, 340b Program Coordinator
(606) 886-8572 Ext: 6677

Addresses

Street Address

1330 S Mayo Trl Ste 201
Pikeville, KY 41501-2321

Billing Address
Same as Street Address

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	7100526560,7100630030,7100770360	1578811774,1265083141,1487221198

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	City	State
CHC24692-00	Active	BPS-H80-012024	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Paintsville	1110 S Mayo Trl STE A	Paintsville	KY
CHC24692-01	Terminated	BPS-H80-014906	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Louisa	130 Town Hill Road, Louisa Plaza Shopping Center	Louisa	KY
CHC24692-02	Active	BPS-H80-017357	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic -Pikeville	118 River Dr	Pikeville	KY
CHC24692-03	Active	BPS-H80-014502	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Prestonsburg	104 S FRONT AVE	PRESTONSBURG	KY
CHC24692-04	Active	BPS-H80-018224	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Belfry	26229 US HIGHWAY 119 N	BELFRY	KY
CHC24692-05	Active	BPS-H80-024729	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Paintsville	838 South Mayo Trail	Paintsville	KY
CHC24692-06	Active	BPS-H80-037019	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Grayson	129 Fraley Miller Plz	Grayson	KY
CHC24692-07	Active	BPS-H80-030097	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Cynthiana	210 S Walnut St	Cynthiana	KY
CHC24692-08	Active	BPS-H80-030720	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Inez	428 E Main St	Inez	KY
CHC24692-09	Active	BPS-H80-032157	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic for Children and Families	1330 S Mayo Trl Ste 201	Pikeville	KY
CHC24692-10	Active	BPS-H80-032137	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Dorton	29 Cabin Frk	Jenkins	KY
CHC24692-11	Active	BPS-H80-033949	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Ashland	2222 Winchester Ave	Ashland	KY
CHC24692-12	Active	BPS-H80-033950	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Winchester	123 N Main Street	Winchester	KY
CHC24692-13	Active	BPS-H80-035776	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace OB/GYN	22 Harbor Ln	Prestonsburg	KY
CHC24692-14	Active	BPS-H80-031726	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Mobile Medical Unit	838 S Mayo Trl	Paintsville	KY
CHC24692-15	Active	BPS-H80-036814	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Martin	263 Ky Route 122	Martin	KY
CHC24692-16	Active	BPS-H80-033788	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Prestonsburg	456 S Lake Dr	Prestonsburg	KY
CHC24692-17	Active	BPS-H80-038896	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	HomePlace Clinic - Louisa	118 Blairs Way	Louisa	KY
CHC24692-18	Active	BPS-H80-038967	MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	The David School	352 Success Bound Rd	David	KY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24692-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CHC24692-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CHC24692-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CHC24692-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CHC24692-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CHC24692-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CHC24692-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CHC24692-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CHC24692-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CHC24692-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2024
CHC24692-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2023
CHC24692-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
CHC24692-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2024
CHC24692-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02380	2409 ARGILLITE ROAD	FLATWOODS	KY	41139	04/01/2023
CHC24692-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06340	197 APPALACHIAN PLAZA	SOUTH WILLIAMSON	KY	41503	04/01/2023
CHC24692-00	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06347	1221 LEXINGTON AVENUE	ASHLAND	KY	41101	04/01/2023
CHC24692-00	MOUNTAIN CARE PHARMACY	24 HARBOR LANE		PRESTONSBURG	KY	41653	07/01/2020	01/13/2023
CHC24692-00	MOUNTAIN CARE PHARMACY	123 N MAIN ST		WINCHESTER	KY	40391-2607	01/01/2022	01/13/2023
CHC24692-00	MOUNTAIN CARE PHARMACY	1330 S MAYO TRL STE 102		PIKEVILLE	KY	41501	10/01/2024
CHC24692-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CHC24692-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2024
CHC24692-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2024
CHC24692-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2023
CHC24692-00	WAL-MART PHARMACY #10-0493	305 LETTON DRIVE		PARIS	KY	40361	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-0591	805 US 27 SOUTH		CYNTHIANA	KY	41031	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-0696	477 VILLAGE DRIVE		PRESTONBURG	KY	41653	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-0702	1859 BYPASS ROAD		WINCHESTER	KY	40391	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-1140	499 INDIAN MOUND DRIVE		MOUNT STERLING	KY	40353	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-1233	470 NO. MAYO TRAIL		PAINTSVILLE	KY	41240	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-1426	351 RIVER HILL ROAD		ASHLAND	KY	41101	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-1505	254 CASSIDY BLVD.		PIKEVILLE	KY	41501	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-2548	28402 U.S. HWY 119 NO.		SO WILLIAMSON	KY	41503	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-2638	12504 U.S. 60		ASHLAND	KY	41102	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-4461	275 WALTON DRIVE		LOUISA	KY	41230	07/01/2023
CHC24692-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2023
CHC24692-00	WAL-MART PHARMACY WHSE #45	2250 NORTH 8TH STREET	SUITE 102-A	ROGERS	AR	72756	10/06/2023	10/06/2023
CHC24692-00	WALGREEN CO	DBA: WALGREENS #10889	2045 BYPASS RD	WINCHESTER	KY	40391-3309	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17164	103 GLYNNVIEW PLZ	PRESTONSBURG	KY	41653	10/01/2023	06/21/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17178	9145 BEAUTY ROAD PO BOX 377	WARFIELD	KY	41267	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17328	9485 HIGHWAY 805	JENKINS	KY	41537	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17404	10 CHARBY HOLLOW RD	MARTIN	KY	41649	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17442	4311 HIGHWAY 2565	LOUISA	KY	41230	10/01/2023	02/21/2024
CHC24692-00	WALGREEN CO.	WALGREENS #17474	308 S MAYO TRL	PAINTSVILLE	KY	41240	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17595	715 PARK AVE	IRONTON	OH	45638	10/01/2023	11/14/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17727	1900 ARGILLITE RD	FLATWOODS	KY	41139	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #17936	5571 COLLINS HWY	PIKEVILLE	KY	41501	10/01/2023	04/07/2025
CHC24692-00	WALGREEN CO.	WALGREENS #17576	244 N LAKE DR	PRESTONSBURG	KY	41653	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #19356	933 BLACKBURN AVE	ASHLAND	KY	41101	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #19545	308 PARKWAY DR	SALYERSVILLE	KY	41465	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #19657	4209 N MAYO TRL	PIKEVILLE	KY	41501	10/01/2023	02/17/2025
CHC24692-00	WALGREEN CO.	WALGREENS #19673	629 US HIGHWAY 27 S	CYNTHIANA	KY	41031	10/01/2023
CHC24692-00	WALGREEN CO.	WALGREENS #19810	3501 COURT ST	CATLETTSBURG	KY	41129	10/01/2023	02/23/2023
CHC24692-00	WALGREEN CO.	WALGREENS #19971	100 S CAROL MALONE BLVD	GRAYSON	KY	41143	10/01/2023
CHC24692-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21170	393 WALLER AVE STE 5	LEXINGTON	KY	40504	10/01/2023
CHC24692-00	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2025
CHC24692-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	10/09/2023
CHC24692-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CHC24692-00	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 10:37:21 AM	2/10/2025 1:10:36 PM	2/10/2025 1:10 PM
Contacts	Primary Contact	Update	Change Request	Cantrell, Elizabeth Clinic Coordinator Mountain Comprehensive Care Center 6064320123	McCoy, Kristi Nicole 340b Program Coordinator Mountain Comprehensive Care Center 6068868572-6677	10/28/2024 1:58 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 1:19:26 PM	1/31/2024 10:37:21 AM	1/31/2024 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/6/2023 12:30 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100630030	10/6/2023 12:30 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	10/6/2023 12:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/6/2023 12:30 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100770360	10/6/2023 12:30 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	10/6/2023 12:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1265083141	5/15/2023 11:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	5/15/2023 11:15 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1487221198	5/15/2023 11:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	5/15/2023 11:15 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 12:35:22 PM	1/30/2023 1:19:26 PM	1/30/2023 1:19 PM
Details	Last Recertification Date	Update	Recertification		1/31/2022 12:35:22 PM	1/31/2022 12:35 PM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Willoughby, Rachel Program Director Mountain Comprehensive Care Center 6068864319	4/21/2021 4:06 PM
Details	340B ID	Update	New Registration		CHC24692-09	4/21/2021 4:06 PM
Dates	Participating Approval Date	Update	New Registration		4/21/2021 4:06:28 PM	4/21/2021 4:06 PM
Details	State	Update	New Registration	Pending	Approved	4/21/2021 4:06 PM
Dates	Signed By Date	Update	New Registration		4/15/2021 7:12:28 PM	4/21/2021 4:06 PM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/21/2021 4:06 PM
Addresses	Main Address	Insert	New Registration		1330 S Mayo Trl Ste 201 Pikeville, KY 41501-2321	4/15/2021 7:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2021 7:12 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100526560	4/15/2021 7:12 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/15/2021 7:12 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1578811774	4/15/2021 7:12 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	4/15/2021 7:12 PM
Contacts	Authorizing Official	Insert	New Registration		Willoughby, Rachel Program Director Mountain Comprehensive Care Center 6068864319	4/15/2021 7:12 PM
Contacts	Primary Contact	Insert	New Registration		Cantrell, Elizabeth Clinic Coordinator Mountain Comprehensive Care Center 6064320123	4/15/2021 7:12 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2021 7:12 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2021 7:12 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2021 7:12 PM
Details	Grant Number	Insert	New Registration		H80CS24692	4/15/2021 7:12 PM
Details	340B ID	Insert	New Registration			4/15/2021 7:12 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2021 7:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2021 7:12 PM
Details	Medicare Provider Number	Insert	New Registration			4/15/2021 7:12 PM
Details	Entity Name	Insert	New Registration		MOUNTAIN COMPREHENSIVE CARE CENTER, INC.	4/15/2021 7:12 PM
Details	NOFO Number	Insert	New Registration			4/15/2021 7:12 PM
Details	Program Code	Insert	New Registration		CH	4/15/2021 7:12 PM
Details	Entity Subname	Insert	New Registration		HomePlace Clinic for Children and Families	4/15/2021 7:12 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2021 7:12 PM
Details	State	Insert	New Registration		Pending	4/15/2021 7:12 PM
Dates	Registration Date	Insert	New Registration		4/15/2021 7:12:25 PM	4/15/2021 7:12 PM
Dates	Signed By Date	Insert	New Registration			4/15/2021 7:12 PM
Dates	Start Date	Insert	New Registration			4/15/2021 7:12 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2021 7:12 PM
Terminations	Termination Date	Insert	New Registration			4/15/2021 7:12 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2021 7:12 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2021 7:12 PM

340B Drug Pricing Program Database