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LAKE CUMBERLAND PHARMACY #2
CH045207AM CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
Russell Springs Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207AM
Entity Address
1554 N HIGHWAY 127
RUSSELL SPRINGS, KY 42642-9502
Grant Number
H80CS08218
Participating Start Date
1/1/2016
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LAKE CUMBERLAND PHARMACY #2
Pharmacy Address
124 DOWELL ROAD
RUSSELL SPRINGS, KY 42642
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
10/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ryan Smith, CFO
(270) 858-6655
Contract Pharmacy Representative
Lake Cumberland Pharmacy
Jonathan Grider, Pharmacist/Owner
(270) 866-2686
Signed By Date
10/5/2023
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