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PARKWAY PHARMACY
CH04060B MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
Subdivision Name
LEATHERWOOD/BLACKEY MEDICAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH04060B
Entity Address
464 Ky Highway 699
Cornettsville, KY 41731-8749
Grant Number
H80CS00367
Participating Start Date
10/1/2004
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
PARKWAY PHARMACY
Pharmacy Address
2354 HIGHWAY 15
PARKWAY PHARMACY
WHITESBURG, KY 41858-7413
Pharmacy Comments
Contract Details
Approval Date
6/9/2010
Contract Begin Date
6/9/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/3/2010
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