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WAL-MART PHARMACY 10-1075
CHC26595-00 PENNYROYAL HEALTHCARE SERVICES INC.
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Covered Entity Details
Entity Name
PENNYROYAL HEALTHCARE SERVICES INC.
Subdivision Name
Community Medical Clinic, Princeton
Type
HRSA-Funded Health Center
340B ID
CHC26595-00
Entity Address
1022 W, Main St.
PRINCETON, KY 42445-1622
Grant Number
H80CS26595
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1075
Pharmacy Address
1680 FT CAMPBELL BLVD
CLARKSVILLE, TN 37042
Pharmacy Comments
Contract Details
Approval Date
10/3/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kecia Fulcher, CEO
(270) 365-0227
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/3/2022
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