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WAL-MART PHARMACY 10-1505
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
WAL-MART PHARMACY 10-1505
Pharmacy Address
254 CASSIDY BLVD.
PIKEVILLE, KY 41501
Pharmacy Comments
Contract Details
Approval Date
4/4/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ELLEN JEAN VANCE, EXECUTIVE DIRECTOR
(606) 487-9505 Ext: 7
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/4/2025
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