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WAL-MART PHARMACY 10-1961
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC.
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Covered Entity Details
Entity Name
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
Lewis County Primary Care Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH048980
Entity Address
211 KY 59
Building A
VANCEBURG, KY 41179
Grant Number
H80CS00106
Participating Start Date
1/1/1999
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1961
Pharmacy Address
6711 ALEXANDRIA PIKE
ALEXANDRIA, KY 41001
Pharmacy Comments
Contract Details
Approval Date
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JERRY UGRIN, CEO
(606) 796-3029
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/10/2018
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