340B Drug Pricing Program Database

Pharmacy Name

LAKE CUMBERLAND PHARMACY #2

Pharmacy Address

124 DOWELL ROAD
RUSSELL SPRINGS, KY 42642

Pharmacy Comments

Approval Date

1/12/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Barry Corbin, Director of Professional Services
(270) 634-3195

Contract Pharmacy Representative

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

Signed By Date

1/12/2015