Contract Pharmacy Details

KENTUCKY CLINIC PHARMACY
RWIIR40621 Kentucky Dept. for Public Health

Covered Entity Details

Entity Name

Kentucky Dept. for Public Health

Subdivision Name

Kentucky HIV/AIDS Program

Type

Ryan White Part B ADAP Rebate Option

340B ID

RWIIR40621

Entity Address

275 E Main St
Frankfort, KY 40621

Grant Number

X07HA00008

Participating Start Date

7/1/2020

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

KENTUCKY CLINIC PHARMACY

Pharmacy Address

UNIVERSITY OF KENTUCKY
740 SOUTH LIMESTONE STREET
J-134 KENTUCKY CLINIC
LEXINGTON, KY 40536

Pharmacy Comments

Contract Details

Approval Date

4/1/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gloria Dennis, Federal Program Specialist/Supervisor
(502) 564-3576

Contract Pharmacy Representative

University of Kentucky Health Care
Anthony B. Tagavi, Senior Director, Community Pharmacy and Ryan White Services
(859) 257-7007

Signed By Date

4/1/2025

340B Drug Pricing Program Database