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EAST MAIN STREET PHARMACY
CH045064A KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
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Covered Entity Details
Entity Name
KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
Subdivision Name
Little Flower Clinic
Type
HRSA-Funded Health Center
340B ID
CH045064A
Entity Address
279 East Main Street
Hazard, KY 41701-1920
Grant Number
H80CS07772
Participating Start Date
4/1/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
EAST MAIN STREET PHARMACY
Pharmacy Address
DACHEA WOOTON
279 E MAIN ST
HAZARD, KY 41701
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ELLEN JEAN VANCE, EXECUTIVE DIRECTOR
(606) 487-9505 Ext: 7
Contract Pharmacy Representative
East Main Street Pharmacy
DACHEA WOOTON, Pharmacist & Owner
(606) 487-0107
Signed By Date
1/11/2019
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