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DAUGHERTY'S DRUG STORE
CH04144L MOUNTAIN PEOPLES' HEALTH COUNCILS, INC.
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Covered Entity Details
Entity Name
MOUNTAIN PEOPLES' HEALTH COUNCILS, INC.
Subdivision Name
Huntsville Elementary School
Type
HRSA-Funded Health Center
340B ID
CH04144L
Entity Address
3221 Baker Hwy.
Huntsville, TN 37756-4014
Grant Number
H80CS00467
Participating Start Date
1/1/2025
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
DAUGHERTY'S DRUG STORE
Pharmacy Address
4160 S HIGHWAY 27
PINE KNOT, KY 42635-9227
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES C. LOVETT, CEO
(423) 286-4141 Ext: 30
Contract Pharmacy Representative
Daugherty's Drugs
Kerry Matheny, Pharmacist
(606) 354-2222
Signed By Date
1/14/2025
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