Contract Pharmacy Details

BOONEVILLE DISCOUNT DRUGS
CH04060D MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.

Covered Entity Details

Entity Name

MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.

Subdivision Name

OWSLEY COUNTY MEDICAL CLINIC

Type

HRSA-Funded Health Center

340B ID

CH04060D

Entity Address

826 KY 11 North
BOONEVILLE, KY 41314

Grant Number

H80CS00367

Participating Start Date

10/1/2004

Last Recertification Date

2/24/2025

Pharmacy Details

Pharmacy Name

BOONEVILLE DISCOUNT DRUGS

Pharmacy Address

478 KY 11 N
BOONEVILLE, KY 41314-9155

Pharmacy Comments

05/31/2012 changed address (was 478 KY 11 North)

Contract Details

Approval Date

5/10/2012

Contract Begin Date

5/10/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/10/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Phillip Hampton, COO
(606) 633-4823 Ext: 1392

Contract Pharmacy Representative

James Fred Carrico, Owner
(606) 593-0382

Signed By Date

4/26/2012

340B Drug Pricing Program Database