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KENTUCKY CVS PHARMACY, L.L.C.
STD41143 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
STD41143
Entity Address
207 N Carol Malone Blvd
Ste. 3
Grayson, KY 41143
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 # 06334
199 LEXINGTON ST
VERSAILLES, KY 40383
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerrel Boyer, Medical Director
(606) 923-1124 Ext: 6062258298
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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