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ISOM COMMUNITY PHARMACY
CH04060J MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
Subdivision Name
HARLAN MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH04060J
Entity Address
132 Village Center Rd
Harlan, KY 40831-1777
Grant Number
H80CS00367
Participating Start Date
10/1/2004
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
ISOM COMMUNITY PHARMACY
Pharmacy Address
93 ISOM PLAZA
P.O. BOX 250
ISOM, KY 41824
Pharmacy Comments
Contract Details
Approval Date
9/12/2011
Contract Begin Date
9/12/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Phillip Hampton, COO
(606) 633-4823 Ext: 1392
Contract Pharmacy Representative
Harlan Medical Center
Ernie Watts, Owner/Operator
(606) 589-0003
Signed By Date
8/23/2011
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