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RITE AID OF KENTUCKY, INC.
CH040670 BIG SANDY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
BIG SANDY HEALTH CARE, INC.
Subdivision Name
BIG SANDY HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH040670
Entity Address
1709 Ky Route 321
Prestonsburg, KY 41653
Grant Number
H80CS00619
Participating Start Date
12/1/1992
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
RITE AID OF KENTUCKY, INC.
Pharmacy Address
RITE AID #2459
10 CHARBY HOLLOW ROAD
MARTIN, KY 41649
Pharmacy Comments
Contract Details
Approval Date
4/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Ownership change
Contacts
Covered Entity Signing Official
Ancil Lewis, Chief Executive Officer
(606) 886-8546 Ext: 1100
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/5/2017
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