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KENTUCKY CVS PHARMACY, L.L.C.
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
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06347
1221 LEXINGTON AVENUE
ASHLAND, KY 41101
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rachel Willoughby, Program Director
(606) 886-4319
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2023
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