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SILVERS HOMETOWN PHARMACY
FQHCLA424 Monticello Medical Associates, Inc
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Covered Entity Details
Entity Name
Monticello Medical Associates, Inc
Subdivision Name
Monticello Medical Associates
Type
Health Center Program Look-Alike
340B ID
FQHCLA424
Entity Address
1 S Creek Dr Ste 102
Monticello, KY 42633-9472
Grant Number
LALCS40210
Participating Start Date
7/1/2021
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
SILVERS HOMETOWN PHARMACY
Pharmacy Address
1251 W COLUMBIA AVE
MONTICELLO, KY 42633
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERT PARMELEE, CEO
(606) 348-3365 Ext: 240
Contract Pharmacy Representative
Silvers Hometown Pharmacy
Joe Silvers, Owner
(606) 343-0101
Signed By Date
7/13/2021
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