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KENTUCKY CVS PHARMACY, L.L.C.
FQHCLA362 Clover Fork Outpatient Medical Project, Inc.
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Covered Entity Details
Entity Name
Clover Fork Outpatient Medical Project, Inc.
Subdivision Name
Clover Fork Evarts
Type
Health Center Program Look-Alike
340B ID
FQHCLA362
Entity Address
101 Chad St
Evarts, KY 40828-8200
Grant Number
LALCS31536
Participating Start Date
4/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06341
533 SKIDMORE DRIVE
HARLAN, KY 40831
Pharmacy Comments
Contract Details
Approval Date
1/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jack Miniard, Chief Executive Officer
(606) 837-2108 Ext: 122
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/6/2023
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