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KENTUCKY CVS PHARMACY, L.L.C.
CH040600 MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
Subdivision Name
Whitesburg Medical/Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH040600
Entity Address
226 Medical Plaza Ln
Whitesburg, KY 41858-7425
Grant Number
H80CS00367
Participating Start Date
10/1/2004
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06341
533 SKIDMORE DRIVE
HARLAN, KY 40831
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
L.M. Caudill, CEO
(606) 633-4823
Contract Pharmacy Representative
Wellpartner
Michael Petryna, National Sales Executive
(720) 377-7745
Signed By Date
4/15/2024
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