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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
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
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2023
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