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EXPRESS SCRIPTS PHARMACY, INC.
CH045064A KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
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Covered Entity Details
Entity Name
KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
Subdivision Name
Little Flower Clinic
Type
HRSA-Funded Health Center
340B ID
CH045064A
Entity Address
279 East Main Street
Hazard, KY 41701-1920
Grant Number
H80CS07772
Participating Start Date
4/1/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/2/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ELLEN JEAN VANCE, EXECUTIVE DIRECTOR
(606) 487-9505 Ext: 7
Contract Pharmacy Representative
Express Scripts
Gene McCabe, 340B Lead Director
(615) 943-7500
Signed By Date
1/2/2025
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