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BOONEVILLE DISCOUNT DRUGS
CH04060H MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
Subdivision Name
BUCKHORN MEDICAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH04060H
Entity Address
72 Buckhorn Clinic Rd
Buckhorn, KY 41721-8936
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
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