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COMMUNITY CARE PHARMACY LLC
FQHCLA422C FAITH HEALTHCARE INC
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Covered Entity Details
Entity Name
FAITH HEALTHCARE INC
Subdivision Name
Hopkinsville Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422C
Entity Address
1841 Peartree Ln
Hopkinsville, KY 42240-4460
Grant Number
LALCS40209
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
COMMUNITY CARE PHARMACY LLC
Pharmacy Address
126 FRANKLIN DR STE 100
MONTICELLO, KY 42633
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
Morgan Dishman, Chief Pharmacy Officer/340B Program Director
(270) 585-9726
Contract Pharmacy Representative
Mount Vernon Drug
Kendall Kilbourne, President
(606) 256-3447
Signed By Date
4/15/2024
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