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KENTUCKY CVS PHARMACY, L.L.C.
CH045207CW CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
Heartland Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207CW
Entity Address
2300 Nelson Dr
Elizabethtown, KY 42701-5945
Grant Number
H80CS08218
Participating Start Date
4/1/2019
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #10048
1571 N DIXIE AVENUE
ELIZABETHTOWN, KY 42701
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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