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EXPRESS SCRIPTS PHARMACY, INC.
CH045207DY CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
West Marion Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207DY
Entity Address
8175 N Loretto Rd
Loretto, KY 40037-8069
Grant Number
H80CS08218
Participating Start Date
10/1/2019
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
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
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
10/5/2023
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