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WAL-MART PHARMACY 10-5997
CH045207DL CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
Vine Grove Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207DL
Entity Address
309 1st St
Vine Grove, KY 40175-1178
Grant Number
H80CS08218
Participating Start Date
4/1/2019
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
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
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/5/2023
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