Contract Pharmacy Details

WALGREEN CO.
CH045207HP Cumberland Family Medical Center, Inc.

Covered Entity Details

Entity Name

Cumberland Family Medical Center, Inc.

Subdivision Name

LeGrande Healthy Kids Clinic

Type

HRSA-Funded Health Center

340B ID

CH045207HP

Entity Address

70 LeGrande School Rd
Horse Cave, KY 42749-7714

Grant Number

H80CS08218

Participating Start Date

4/1/2023

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17438
394 N DIXIE ST
HORSE CAVE, KY 42749

Pharmacy Comments

Contract Details

Approval Date

10/5/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/24/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Ryan Smith, CFO
(270) 858-6655

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/5/2023

340B Drug Pricing Program Database