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KENTUCKY CVS PHARMACY, L.L.C.
HV00536 University of Louisville Research Foundation/Wings Clinic
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Covered Entity Details
Entity Name
University of Louisville Research Foundation/Wings Clinic
Subdivision Name
Type
Ryan White Part C
340B ID
HV00536
Entity Address
550 South Jackson Street
550 Clinic, ACB 2nd Floor
Louisville, KY 40202
Grant Number
H76HA00536
Participating Start Date
1/1/2012
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #10048
1571 N DIXIE AVENUE
ELIZABETHTOWN, KY 42701
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anupama Raghuram, Project Director/Medical Director, 550 Clinic
(502) 561-8825
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2020
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