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SOUTH CREEK DRUG
FQHCLA422 Faith Healthcare, Inc
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Covered Entity Details
Entity Name
Faith Healthcare, Inc
Subdivision Name
Community Care Clinic, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA422
Entity Address
126 Franklin Rd
Monticello, KY 42633-2245
Grant Number
LALCS40209
Participating Start Date
3/12/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SOUTH CREEK DRUG
Pharmacy Address
130 WALMART PLAZA DR UNIT 1
MONTICELLO, KY 42633-7943
Pharmacy Comments
Contract Details
Approval Date
3/11/2021
Contract Begin Date
3/12/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Carnes, 340B Program Co-Director/Chief Pharmacy Officer
(270) 566-1074
Contract Pharmacy Representative
South Creek Drug
James Staton, Pharmacist
(606) 348-1800
Signed By Date
3/11/2021
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