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UNIVERSITY MEDICAL CENTER
STD40202 University of Louisville Research Foundation/WINGS Clinic
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Covered Entity Details
Entity Name
University of Louisville Research Foundation/WINGS Clinic
Subdivision Name
Medicine Infectious Diseases/550 Clinic
Type
Sexually Transmitted Diseases
340B ID
STD40202
Entity Address
550 South Jackson Street
550 Clinic, ACB 2nd Floor
Louisville, KY 40202
Grant Number
6 NU62PS924618-01-0
Participating Start Date
8/30/2021
Last Recertification Date
6/3/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY MEDICAL CENTER
Pharmacy Address
UNIVERSITY OF LOUISVILLE HOSP
AMBULATORY CARE PHARMACY
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bailey Bolten, Clinical Pharmacist
(502) 852-7668
Contract Pharmacy Representative
UofL Health
Robert Michael Fink, System Director
(502) 217-5095
Signed By Date
10/6/2023
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