Covered Entity Details

CH045064B Kentucky Mountain Health Alliance, Inc. (Active) - information as of 6/19/2025 11:48:59 PM

Main Details

Name

Kentucky Mountain Health Alliance, Inc.

Subdivision Name

Kentucky Mountain Health Alliance Inc.

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032302

340B ID

CH045064B

Grant Number

H80CS07772

Additional Details

Current Program Status

Active

Registration Date

4/3/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/3/2023

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
ELLEN JEAN VANCE, EXECUTIVE DIRECTOR
(606) 487-9505 Ext: 7

Primary Contact

Kentucky Mountain Health Alliance, Inc.
Rebecca Cheek, 340b Auditor
(606) 487-9505

Addresses

Street Address

279 E Main St
Hazard, KY 41701-1973

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	7100571230	1407043979

Shipping Addresses

Shipping Address 1

Little Flower Clinic
279 East Main St.
Ste. 200
Hazard, KY 41701-1920

Shipping Address 2

Quantum Healthcare
210 Black Gold Blvd.
Ste. 106
Hazard, KY 41701

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
Contract Detail	ARH SPECIALTY PHARMACY	DBA OF APPALACHIAN REGIONAL HEALTHCARE,	200 MEDICAL CENTER DR SUITE A	HAZARD	KY	41701-9466	10/06/2024	01/01/2025			01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH045064A	Active	BPS-H80-021949	KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.	Little Flower Clinic	279 East Main Street	Hazard	KY
CH045064B	Active	BPS-H80-032302	Kentucky Mountain Health Alliance, Inc.	Kentucky Mountain Health Alliance Inc.	279 E Main St	Hazard	KY
CH045064C	Active	BPS-H80-036829	Kentucky Mountain Health Alliance, Inc.	Quantum Healthcare Associates, Inc.	210 Black Gold Blvd	Hazard	KY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH045064A	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2025
CH045064A	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2025
CH045064A	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2025
CH045064A	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2025
CH045064A	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2025
CH045064A	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2025
CH045064A	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
CH045064A	APPALACHIAN REGIONAL HEALTHCARE, INC.	DBA ARH COMMUNITY PHARMACY	210 BLACK GOLD BLVD STE 104	HAZARD	KY	41701-2620	01/01/2024
CH045064A	APPALACHIAN REGIONAL HEALTHCARE, INC.	DBA ARH HAZARD PHARMACY	181 ROY CAMPBELL DR	HAZARD	KY	41701	01/01/2024
CH045064A	APPALACHIAN REGIONAL HLTHCARE	DBA HAZARD ARH REGIONAL MED CENTER CLINI	200 MEDICAL CENTER DR	HAZARD	KY	41701-9466	01/01/2024
CH045064A	ARH SPECIALTY PHARMACY	DBA OF APPALACHIAN REGIONAL HEALTHCARE,	200 MEDICAL CENTER DR SUITE A	HAZARD	KY	41701-9466	01/01/2024
CH045064B	ARH SPECIALTY PHARMACY	DBA OF APPALACHIAN REGIONAL HEALTHCARE,	200 MEDICAL CENTER DR SUITE A	HAZARD	KY	41701-9466	01/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
CH045064A	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
CH045064A	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2024
CH045064A	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2024
CH045064A	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2024
CH045064A	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2024
CH045064A	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2024
CH045064A	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
CH045064A	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2024
CH045064A	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2024
CH045064A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2024
CH045064A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2024
CH045064A	COMPLETE CARE PHARMACY	572 MORTON BLVD		HAZARD	KY	41701	10/01/2023
CH045064A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2023
CH045064A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2023
CH045064A	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2024
CH045064A	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
CH045064A	EAST MAIN STREET PHARMACY	DACHEA WOOTON	279 E MAIN ST	HAZARD	KY	41701	04/01/2019
CH045064A	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2025
CH045064A	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2025
CH045064A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2025
CH045064A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2025
CH045064A	GENOA HEALTHCARE LLC	1351 NEWTOWN PIKE	BUILDING 5	LEXINGTON	KY	40511-1282	10/01/2024
CH045064A	GRACE PHARMACY, LLC	546 PARKERS MILL RD UNIT B		SOMERSET	KY	42501	10/01/2024
CH045064A	K-VA-T FOOD STORES INC	FOOD CITY PHARMACY #437	2478 S US HIGHWAY 421	HARLAN	KY	40831	10/01/2024
CH045064A	KENTUCKY CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10155	102 VILLAGE LANE	HAZARD	KY	41701	10/01/2023
CH045064C	KENTUCKY CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10155	102 VILLAGE LANE	HAZARD	KY	41701	01/01/2025
CH045064A	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	07/01/2024
CH045064A	KROGER PHARMACY L-355	515 N 12TH STREET		MIDDLESBORO	KY	40965	07/01/2024
CH045064A	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	10/01/2024
CH045064A	OPTUM INFUSION SERVICES 550, LLC	7167 E. KEMPER RD.		CINCINNATI	OH	45249	10/01/2024
CH045064A	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH045064A	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2024
CH045064A	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH045064A	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CH045064A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2024
CH045064A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2024
CH045064A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2024
CH045064A	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2025
CH045064A	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
CH045064A	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2025
CH045064A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2023
CH045064A	WAL-MART PHARMACY 10-0552	350 WHITESBURG PLAZA		WHITESBURG	KY	41858	10/01/2023
CH045064A	WAL-MART PHARMACY 10-0693	1589 KY HWY 15 SOUTH		JACKSON	KY	41339	10/01/2023
CH045064A	WAL-MART PHARMACY 10-1113	1851 WEST HWY 192		LONDON	KY	40741	10/01/2023
CH045064A	WAL-MART PHARMACY 10-1190	120 JILL DRIVE		BEREA	KY	40403	10/01/2023
CH045064A	WAL-MART PHARMACY 10-1247	120 DANIEL BOONE PLAZA		HAZARD	KY	41701	10/01/2023
CH045064A	WAL-MART PHARMACY 10-1505	254 CASSIDY BLVD.		PIKEVILLE	KY	41501	07/01/2025
CH045064A	WAL-MART PHARMACY 10-1743	201 WALTON ROAD		HARLAN	KY	40831	10/01/2023
CH045064A	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2024
CH045064A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2023
CH045064A	WALGREEN CO.	WALGREENS #19026	426 VILLAGE LN	HAZARD	KY	41701	10/01/2024	09/30/2024
CH045064A	WALGREEN CO.	WALGREENS #17162	21287 HIGHWAY 421 PO BOX 1665	HYDEN	KY	41749	10/01/2024
CH045064A	WALGREEN CO.	WALGREENS #18059	100 HOLLY HILLS MALL RD	HINDMAN	KY	41822	10/01/2024
CH045064A	WALGREEN CO.	WALGREENS #17526	740 HIGHWAY 15 S	JACKSON	KY	41339	10/01/2024
CH045064A	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/01/2024
CH045064A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023
CH045064A	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	1/29/2024 11:08:28 AM	2/11/2025 4:01:45 PM	2/11/2025 4:01 PM
Contacts	Primary Contact	Update	Change Request	Cheek, Rebecca 340b Auditor Cheek Consulting 6065241303	Cheek, Rebecca 340b Auditor Kentucky Mountain Health Alliance, Inc. 6064879505	9/30/2024 11:17 AM
Addresses	Shipping Address	Insert	Change Request		Little Flower Clinic 279 East Main St. Ste. 200 Hazard, KY 41701-1920	4/11/2024 12:29 PM
Addresses	Shipping Address	Insert	Change Request		Quantum Healthcare 210 Black Gold Blvd. Ste. 106 Hazard, KY 41701	4/11/2024 12:29 PM
Details	Last Recertification Date	Update	Recertification		1/29/2024 11:08:28 AM	1/29/2024 11:08 AM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		VANCE, ELLEN JEAN EXECUTIVE DIRECTOR KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC. 6064879505-7	4/3/2023 10:38 AM
Details	340B ID	Update	New Registration		CH045064B	4/3/2023 10:38 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2023 10:38:41 AM	4/3/2023 10:38 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2023 10:38 AM
Dates	Signed By Date	Update	New Registration		4/3/2023 9:46:48 AM	4/3/2023 10:38 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/3/2023 10:38 AM
Addresses	Main Address	Insert	New Registration		279 E Main St Hazard, KY 41701-1973	4/3/2023 9:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2023 9:46 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100571230	4/3/2023 9:46 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/3/2023 9:46 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1407043979	4/3/2023 9:46 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	4/3/2023 9:46 AM
Contacts	Authorizing Official	Insert	New Registration		VANCE, ELLEN JEAN EXECUTIVE DIRECTOR KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC. 6064879505-7	4/3/2023 9:46 AM
Contacts	Primary Contact	Insert	New Registration		Cheek, Rebecca 340b Auditor Cheek Consulting 6065241303	4/3/2023 9:46 AM
Details	Assistance Received From Date	Insert	New Registration			4/3/2023 9:46 AM
Details	Assistance Received To Date	Insert	New Registration			4/3/2023 9:46 AM
Details	Last Recertification Date	Insert	New Registration			4/3/2023 9:46 AM
Details	Grant Number	Insert	New Registration		H80CS07772	4/3/2023 9:46 AM
Details	340B ID	Insert	New Registration			4/3/2023 9:46 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2023 9:46 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2023 9:46 AM
Details	Medicare Provider Number	Insert	New Registration			4/3/2023 9:46 AM
Details	Entity Name	Insert	New Registration		Kentucky Mountain Health Alliance, Inc.	4/3/2023 9:46 AM
Details	NOFO Number	Insert	New Registration			4/3/2023 9:46 AM
Details	Program Code	Insert	New Registration		CH	4/3/2023 9:46 AM
Details	Entity Subname	Insert	New Registration		Kentucky Mountain Health Alliance Inc.	4/3/2023 9:46 AM
Dates	Participating Approval Date	Insert	New Registration			4/3/2023 9:46 AM
Details	State	Insert	New Registration		Pending	4/3/2023 9:46 AM
Dates	Registration Date	Insert	New Registration		4/3/2023 9:46:44 AM	4/3/2023 9:46 AM
Dates	Signed By Date	Insert	New Registration			4/3/2023 9:46 AM
Dates	Start Date	Insert	New Registration			4/3/2023 9:46 AM
Terminations	Termination Comments	Insert	New Registration			4/3/2023 9:46 AM
Terminations	Termination Date	Insert	New Registration			4/3/2023 9:46 AM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2023 9:46 AM
Terminations	Termination Reason	Insert	New Registration			4/3/2023 9:46 AM

340B Drug Pricing Program Database