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MIKE'S PHARMACY
CHC17157-00 REGIONAL HEALTH CARE AFFILIATES, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE AFFILIATES, INC.
Subdivision Name
Regional Health Care Affiliates, Inc. Doing Business As Health First CHC - Providence
Type
HRSA-Funded Health Center
340B ID
CHC17157-00
Entity Address
215 East Main Street
Providence, KY 42450-1261
Grant Number
H80CS17157
Participating Start Date
7/1/2010
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MIKE'S PHARMACY
Pharmacy Address
104 SOUTH L.T. TODD JR HWY
EARLINGTON, KY 42410-4241
Pharmacy Comments
Contract Details
Approval Date
4/8/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/21/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bill Smith, CEO
(270) 667-7017 Ext: 2101
Contract Pharmacy Representative
MIKE SEIBER, PHARMACISTS
(270) 905-4046
Signed By Date
4/8/2016
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