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MEDICINE SHOPPE OF HYDEN
CHC09959-00 GRACE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GRACE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Grace Community Health Center, Inc
Type
HRSA-Funded Health Center
340B ID
CHC09959-00
Entity Address
39 Cumberland Gap Plaza
Gray, KY 40734
Grant Number
H80CS09959
Participating Start Date
10/1/2010
Last Recertification Date
2/1/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE OF HYDEN
Pharmacy Address
22044 MAIN ST
PO BOX 455
HYDEN, KY 41749-8568
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Stanley, Chief Executive Officer
(606) 526-9005
Contract Pharmacy Representative
Medicine Shoppe
Keith Stewart, Manager
(606) 672-8705
Signed By Date
4/14/2014
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