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KENTUCKY CVS PHARMACY, L.L.C.
CH045207GG Cumberland Family Medical Center, Inc.
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Covered Entity Details
Entity Name
Cumberland Family Medical Center, Inc.
Subdivision Name
Taylor Family Medical Center
Type
HRSA-Funded Health Center
340B ID
CH045207GG
Entity Address
101 Winston Way STE C & D
Campbellsville, KY 42718
Grant Number
H80CS08218
Participating Start Date
10/1/2022
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06338
101 EAST BROADWAY
CAMPBELLSVILLE, KY 42718
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Smith, CFO
(270) 858-6655
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/5/2023
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