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PDC, LLC
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
PDC, LLC
Pharmacy Address
PRINCETON DRUG STORE
103 W MAIN ST
PRINCETON, KY 42445
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
1/12/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shelley Renea Gobin, CEO
(270) 667-2535 Ext: 2104
Contract Pharmacy Representative
Princeton Drug Store
Jimmy Tucker, Pharmacist/Owner
(270) 365-5585
Signed By Date
1/11/2018
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