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MOUNTAIN COMMUNITY PHARMACY
STD417012 Mountain After-Hours Clinic, P.S.C.
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Covered Entity Details
Entity Name
Mountain After-Hours Clinic, P.S.C.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD417012
Entity Address
1908 North Main Street
Hazard, KY 41701
Grant Number
NH25PS005135
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
MOUNTAIN COMMUNITY PHARMACY
Pharmacy Address
1908 N MAIN ST
STE 108
HAZARD, KY 41701
Pharmacy Comments
Contract Details
Approval Date
11/5/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Thomas Yonts, Medical Director
(606) 439-2662
Contract Pharmacy Representative
Mountain Community Pharmacy
Carrie Combs, Pharmacist
(606) 487-0023
Signed By Date
10/7/2024
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