Contract Pharmacy Details

WALGREEN CO.
CH045207AE CUMBERLAND FAMILY MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

CUMBERLAND FAMILY MEDICAL CENTER, INC.

Subdivision Name

Cumberland County High Healthy Kids Clinic

Type

HRSA-Funded Health Center

340B ID

CH045207AE

Entity Address

912 N Main St
Burkesville, KY 42717

Grant Number

H80CS08218

Participating Start Date

1/1/2016

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #18303
1000 GAINESBORO HIGHWAY
CELINA, TN 38551

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

2/25/2025
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