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STANFORD DRUG
FQHCLA422C FAITH HEALTHCARE INC
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Covered Entity Details
Entity Name
FAITH HEALTHCARE INC
Subdivision Name
Hopkinsville Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422C
Entity Address
1841 Peartree Ln
Hopkinsville, KY 42240-4460
Grant Number
LALCS40209
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
STANFORD DRUG
Pharmacy Address
107 METKER TRL STE D
PO BOX 364
STANFORD, KY 40484-1049
Pharmacy Comments
Contract Details
Approval Date
9/8/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Carnes, 340B Program Co-Director/Chief Pharmacy Officer
(270) 566-1074
Contract Pharmacy Representative
Mount Vernon Drug
Kendall Kilbourne, President
(606) 256-3447
Signed By Date
7/17/2023
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