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WYNN EXPRESS PHARMACY
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
WYNN EXPRESS PHARMACY
Pharmacy Address
43 MEDICAL LANE
WHITLEY CITY, KY 42653
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
ERIC E. LOY, CEO
(270) 864-2889
Contract Pharmacy Representative
Sue Wynn, Pharmacist/Owner
(606) 376-1535
Signed By Date
7/15/2016
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