Contract Pharmacy Details

LAKE CUMBERLAND PHARMACY #2
CH0452070 CUMBERLAND FAMILY MEDICAL CENTER, INC.

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

LAKE CUMBERLAND PHARMACY #2

Pharmacy Address

124 DOWELL RD
RUSSELL SPRINGS, KY 42642

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

10/30/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ERIC E. LOY, CEO
(270) 864-2889

Contract Pharmacy Representative

Russell County Hospital
Jonathan Grider, Managing Member
(270) 858-6400

Signed By Date

7/15/2016

340B Drug Pricing Program Database