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KENTUCKY CVS PHARMACY, L.L.C.
STD41101 Fresh Start Health PSC
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Covered Entity Details
Entity Name
Fresh Start Health PSC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD41101
Entity Address
336 29th Street
Suite 203
Ashland, KY 41101
Grant Number
6NH25PS005135-01-01
Participating Start Date
4/1/2023
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02380
2409 ARGILLITE ROAD
FLATWOODS, KY 41139
Pharmacy Comments
Contract Details
Approval Date
1/11/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerrel Boyer, Medical Director
(606) 923-1124 Ext: 6062258298
Contract Pharmacy Representative
Wellpartner
Michael Petryna, National Sales Executive
(720) 377-7745
Signed By Date
1/11/2025
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