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MOUNTAIN CARE PHARMACY
CHC24692-00 MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
Subdivision Name
HomePlace Clinic - Paintsville
Type
HRSA-Funded Health Center
340B ID
CHC24692-00
Entity Address
1110 S Mayo Trl STE A
Paintsville, KY 41240-1273
Grant Number
H80CS24692
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN CARE PHARMACY
Pharmacy Address
123 N MAIN ST
WINCHESTER, KY 40391-2607
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rachel Willoughby, Program Director
(606) 886-4319
Contract Pharmacy Representative
Mountain Comprehensive Care Center
Amanda Barber, 340B Contact
(606) 886-8572
Signed By Date
10/14/2021
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