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KENTUCKY CVS PHARMACY, L.L.C.
CH040650 PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Park DuValle Community Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH040650
Entity Address
3015 Wilson Ave
Louisville, KY 40211-1969
Grant Number
H80CS00083
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06210
340 W. MUHAMMAD ALI BLVD.
LOUISVILLE, KY 40202
Pharmacy Comments
Contract Details
Approval Date
1/10/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Swannie Jett, CEO
(502) 774-4401
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/10/2025
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