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KENTUCKY CVS PHARMACY, L.L.C.
STD42064 Tri-Rivers Healthcare, PLLC
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Covered Entity Details
Entity Name
Tri-Rivers Healthcare, PLLC
Subdivision Name
Marion Physicians Clinic
Type
Sexually Transmitted Diseases
340B ID
STD42064
Entity Address
308 S Main Street
Marion, KY 42064
Grant Number
NH25PS005135
Participating Start Date
1/1/2024
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06377
920 N. MAIN ST.
MADISONVILLE, KY 42431
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael A Heneisen, Business Manager
(270) 988-3298
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2024
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