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WAL-MART PHARMACY 10-2548
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
WAL-MART PHARMACY 10-2548
Pharmacy Address
28402 U.S. HWY 119 NO.
SO WILLIAMSON, KY 41503
Pharmacy Comments
Contract Details
Approval Date
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rachel Willoughby, Program Director
(606) 886-4319
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/13/2023
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