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WAYNE COUNTY PHARMACY
FQHCLA422 Faith Healthcare, Inc
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Covered Entity Details
Entity Name
Faith Healthcare, Inc
Subdivision Name
Community Care Clinic, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA422
Entity Address
126 Franklin Rd
Monticello, KY 42633-2245
Grant Number
LALCS40209
Participating Start Date
3/12/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAYNE COUNTY PHARMACY
Pharmacy Address
268 ROLLING HILLS BLVD
MONTICELLO, KY 42633
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Timothy Carnes, 340B Program Co-Director/Chief Pharmacy Officer
(270) 566-1074
Contract Pharmacy Representative
Wayne County Pharmacy
Patricia Huff, Manager
(606) 753-0150
Signed By Date
10/13/2022
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