Contract Pharmacy Details

KENTUCKY CVS PHARMACY, L.L.C.
CHC09959-00 GRACE COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

GRACE COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Grace Community Health Center, Inc

Type

HRSA-Funded Health Center

340B ID

CHC09959-00

Entity Address

39 Cumberland Gap Plaza
Gray, KY 40734

Grant Number

H80CS09959

Participating Start Date

10/1/2010

Last Recertification Date

2/1/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

KENTUCKY CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06343
30 S KY HIGHWAY 15
HAZARD, KY 41701

Pharmacy Comments

Contract Details

Approval Date

1/7/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/21/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Michael W Stanley, Chief Executive Officer
(606) 526-9005

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/7/2020

340B Drug Pricing Program Database