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WAL-MART PHARMACY 10-2654
CH0452070 CUMBERLAND FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CUMBERLAND FAMILY MEDICAL CENTER, INC.
Subdivision Name
CUMBERLAND FAMILY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH0452070
Entity Address
360 KEEN STREET
BURKESVILLE, KY 42717
Grant Number
H80CS08218
Participating Start Date
1/1/2008
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2654
Pharmacy Address
1650 EDMONTON ROAD
TOMPKINSVILLE, KY 42167
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC E. LOY, CEO
(270) 864-2889
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/10/2014
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