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WAL-MART PHARMACY 10-1113
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
WAL-MART PHARMACY 10-1113
Pharmacy Address
1851 WEST HWY 192
LONDON, KY 40741
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael W Stanley, Chief Executive Officer
(606) 526-9005
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/12/2018
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