Contract Pharmacy Details

WALGREEN CO.
CHC26595-00 PENNYROYAL HEALTHCARE SERVICES INC.

Covered Entity Details

Entity Name

PENNYROYAL HEALTHCARE SERVICES INC.

Subdivision Name

Community Medical Clinic, Princeton

Type

HRSA-Funded Health Center

340B ID

CHC26595-00

Entity Address

1022 W, Main St.
PRINCETON, KY 42445-1622

Grant Number

H80CS26595

Participating Start Date

7/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

RITE AID #07890
2626 FORT CAMPBELL BLVD
HOPKINSVILLE, KY 42240

Pharmacy Comments

Contract Details

Approval Date

2/5/2018

Contract Begin Date

2/5/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/5/2018
Ownership change

Contacts

Covered Entity Signing Official

Kecia Fulcher, CEO
(270) 365-0227

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

2/5/2018

340B Drug Pricing Program Database