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SOUTH CREEK DRUG
FQHCLA422A Faith Healthcare, Inc
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Covered Entity Details
Entity Name
Faith Healthcare, Inc
Subdivision Name
Nancy Family Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422A
Entity Address
9919 W Highway 80
Nancy, KY 42544-9003
Grant Number
LALCS40209
Participating Start Date
9/10/2021
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
9/10/2021
Contract Begin Date
9/10/2021
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
9/9/2021
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