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KENTUCKY CENTRAL FILL FACILITY, L-010
CH08022D COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
72nd STREET CLINIC
Type
HRSA-Funded Health Center
340B ID
CH08022D
Entity Address
220 WEST 7200 SOUTH
SUITE A
MIDVALE, UT 84047-1043
Grant Number
H80CS00220
Participating Start Date
7/1/1995
Last Recertification Date
2/10/2025
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
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEXTER PEARCE, Executive Director
(801) 412-6920
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/13/2020
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