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KENTUCKY CVS PHARMACY, L.L.C.
CHC17157-00 REGIONAL HEALTH CARE AFFILIATES, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE AFFILIATES, INC.
Subdivision Name
Regional Health Care Affiliates, Inc. Doing Business As Health First CHC - Providence
Type
HRSA-Funded Health Center
340B ID
CHC17157-00
Entity Address
215 East Main Street
Providence, KY 42450-1261
Grant Number
H80CS17157
Participating Start Date
7/1/2010
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06377
920 N. MAIN ST.
MADISONVILLE, KY 42431
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/12/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Shelley Renea Gobin, CEO
(270) 667-2535 Ext: 2104
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2019
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