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KENTUCKY CVS PHARMACY, L.L.C.
HV00536 University of Louisville Research Foundation/Wings Clinic
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Covered Entity Details
Entity Name
University of Louisville Research Foundation/Wings Clinic
Subdivision Name
Type
Ryan White Part C
340B ID
HV00536
Entity Address
550 South Jackson Street
550 Clinic, ACB 2nd Floor
Louisville, KY 40202
Grant Number
H76HA00536
Participating Start Date
1/1/2012
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06217
9575 TAYLORSVILLE RD.
JEFFERSONTOWN, KY 40299
Pharmacy Comments
Contract Details
Approval Date
7/20/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bailey Bolten, Clinical Pharmacist
(502) 852-7668
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/20/2023
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