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WAYNE COUNTY PHARMACY
FQHCLA422E FAITH HEALTHCARE INC
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Covered Entity Details
Entity Name
FAITH HEALTHCARE INC
Subdivision Name
Mount Vernon Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422E
Entity Address
525 Richmond St
Mount Vernon, KY 40456-2718
Grant Number
LALCS40209
Participating Start Date
4/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAYNE COUNTY PHARMACY
Pharmacy Address
268 ROLLING HILLS BLVD
MONTICELLO, KY 42633
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Morgan Dishman, Chief Pharmacy Officer/340B Program Director
(270) 585-9726
Contract Pharmacy Representative
Wayne County Pharmacy
Patricia Huff, Manager
(606) 753-0150
Signed By Date
4/15/2024
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