340B Drug Pricing Program Database
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CH04898C LEWIS COUNTY PRIMARY CARE CENTER, INC (Active)
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Main Details
Name
LEWIS COUNTY PRIMARY CARE CENTER, INC
Subdivision Name
Tollesboro Family Health Center & Clinic Pharmacy
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001838
340B ID
CH04898C
Grant Number
H80CS00106
Additional Details
Current Program Status
Active
Registration Date
7/1/2002
Participating Start Date
7/1/2002
Participating Approval Date
8/5/2004
Last Recertification Date
2/26/2025
Contacts
Authorizing Official
Lewis County Primary Care Center, Inc.
JERRY UGRIN, CEO
(606) 796-3029
Primary Contact
Lewis County Primary Care Center, Inc.
Chad Evans, PharmD
(606) 956-0188
Addresses
Street Address
17521 W Ky 9
TOLLESBORO, KY 41189-8243
Billing Address
LEWIS COUNTY PRIMARY CARE CENTER, INC.
PO BOX 550
Vanceburg, KY 41179
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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11/23/10 UPDATED PHYS ADD (WAS ROUTE 1, BOX 1005), ADDED BILL-TO ADD; CORRECTED 340B ID AND ENTITY NAME - WAS CH04898B
11/23/2010
May 2025
May 2025
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