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KENTUCKY CENTRAL FILL FACILITY, L-010
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 CENTRAL FILL FACILITY, L-010
Pharmacy Address
5594 SHEPHERDSVILLE ROAD
LOUISVILLE, KY 40228-1012
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Shelley Renea Gobin, CEO
(270) 667-2535 Ext: 2104
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/15/2019
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