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VICCO PHARMACY
STD417011 Primary Care Center Centers of Eastern Kentucky
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Covered Entity Details
Entity Name
Primary Care Center Centers of Eastern Kentucky
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD417011
Entity Address
101 TOWN AND COUNTRY LANE
Hazard, KY 41701
Grant Number
NH25PS005135
Participating Start Date
10/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
VICCO PHARMACY
Pharmacy Address
10616 S KY HIGHWAY 15
SCUDDY, KY 41760-9031
Pharmacy Comments
Contract Details
Approval Date
8/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry Martin, CEO
(606) 439-1300
Contract Pharmacy Representative
Primary Care Centers of Eastern Kentucky, LLC
Wesley Huff, Director of Pharmacy
(606) 435-0460 Ext: 4406
Signed By Date
7/9/2024
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