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RITE AID OF KENTUCKY, INC.
CH046840 FAMILY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS, INC.
Subdivision Name
FAMILY HEALTH CENTERS, INC./FAMILY HEALTH CENTER - PORTLAND
Type
HRSA-Funded Health Center
340B ID
CH046840
Entity Address
2215 Portland Ave
Attn:Pharmacy
Louisville, KY 40212-1033
Grant Number
H80CS00102
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF KENTUCKY, INC.
Pharmacy Address
RITE AID #4849
4838 POPLAR LEVEL ROAD
LOUISVILLE, KY 40213
Pharmacy Comments
Contract Details
Approval Date
7/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2018
Ownership change
Contacts
Covered Entity Signing Official
BILL B WAGNER, CEO
(502) 778-4201
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
7/7/2014
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