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RUSSELL SPRINGS PHARMACY
CH045207AN CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
Salem Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207AN
Entity Address
1409 S HIGHWAY 76
RUSSELL SPRINGS, KY 42642-9612
Grant Number
H80CS08218
Participating Start Date
1/1/2016
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
RUSSELL SPRINGS PHARMACY
Pharmacy Address
92 JOE T PETTY DR
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
Contacts
Covered Entity Signing Official
Ryan Smith, CFO
(270) 858-6655
Contract Pharmacy Representative
Jamestown Pharmacy
Jeff Warner, Pharmacist
(270) 343-4443
Signed By Date
10/5/2023
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