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KENTUCKY CVS PHARMACY, L.L.C.
STD338441 Diversity Healthcare
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Covered Entity Details
Entity Name
Diversity Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD338441
Entity Address
1011 E Main St Suite A
Haines City, FL 33844
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 17759
500 SOUTH UPPER STREET
SUITE 100
LEXINGTON, KY 40508
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clayton Dale Reedy, Owner/Provider
(937) 307-7891
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/9/2024
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