Contract Pharmacy Details

AMAZON PHARMACY #001
CHC17157-00 REGIONAL HEALTH CARE AFFILIATES, INC.

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

AMAZON PHARMACY #001

Pharmacy Address

4500 S PLEASANT VALLEY RD STE 201
AUSTIN, TX 78744-2911

Pharmacy Comments

Contract Details

Approval Date

9/4/2020

Contract Begin Date

9/8/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/4/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Shelley Renea Gobin, CEO
(270) 667-2535 Ext: 2104

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

9/4/2020

340B Drug Pricing Program Database