340B Drug Pricing Program Database


CHC24149-05 MERCY HEALTH SERVICES, INC. (Active) - information as of 4/29/2025 1:38:24 AM

Main Details
MERCY HEALTH SERVICES, INC.
Mercy office at Marshall Co Oak Grove Elementary
HRSA-Funded Health Center
BPS-H80-024538
CHC24149-05
H80CS24149


Additional Details
Active
11/7/2024
1/1/2025
11/12/2024
2/21/2025

Contacts

Mercy Community Healthcare
Rhonda Sizemore, CFO
(615) 790-0567 Ext: 206

Mercy Community Healthcare
Martha M Irvin, Controller
(615) 790-0567 Ext: 6101

Addresses

1645 Franklin Pike
Lewisburg, TN 37091-6916

Mercy Health Services, Inc.
143 SE Parkway Ct
Franklin, TN 37064


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailWALGREEN CO.DBA: WALGREENS # 01989 4932 MAIN STREET
SPRING HILLTN37174-826211/12/202401/01/2025  01/01/2025
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC24149-00ActiveBPS-H80-037568MERCY HEALTH SERVICES, INC.Mercy Health Services143 SE Parkway Ct FranklinTN
CHC24149-01TerminatedBPS-H80-014101MERCY HEALTH SERVICES, INC.Mercy Health Services, Inc1113 Murfreesboro Rd STE 202 FranklinTN
CHC24149-02ActiveBPS-H80-027763Mercy Health Services, Inc.Mercy Marshall County - 122 East Commerce Street122 E Commerce St LewisburgTN
CHC24149-03ActiveBPS-H80-027503MERCY HEALTH SERVICES, INC.Mercy office at FSSD Moore Elementary School1061 Lewisburg Pike FranklinTN
CHC24149-04ActiveBPS-H80-021509MERCY HEALTH SERVICES, INC.Mercy office at FSSD Freedom Middle school1000 Excellence Way FranklinTN
CHC24149-05ActiveBPS-H80-024538MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Oak Grove Elementary1645 Franklin Pike LewisburgTN
CHC24149-06ActiveBPS-H80-024544MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Cornersville Elementary485 N Main St CornersvilleTN
CHC24149-07ActiveBPS-H80-027500MERCY HEALTH SERVICES, INC.Mercy office at FSSD Liberty Elementary School600 Liberty Pike FranklinTN
CHC24149-08ActiveBPS-H80-027438MERCY HEALTH SERVICES, INC.Mercy office at FSSD Franklin Elementary School1501 Figuers Dr FranklinTN
CHC24149-09ActiveBPS-H80-027501MERCY HEALTH SERVICES, INC.Mercy office at FSSD Freedom Intermediate School840 Glass Ln FranklinTN
CHC24149-10ActiveBPS-H80-024865MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Forrest Middle/High School310 N Horton Pkwy Chapel HillTN
CHC24149-11ActiveBPS-H80-024869MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Delk Henson Intermediate425 S Horton Pkwy Chapel HillTN
CHC24149-12ActiveBPS-H80-024867MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Chapel Hill Elementary4795 Nashville Hwy Chapel HillTN
CHC24149-13ActiveBPS-H80-027762MERCY HEALTH SERVICES, INC.Mercy office at FSSD Poplar Grove Elementary/Middle School1030 Excellence Way FranklinTN
CHC24149-14ActiveBPS-H80-024498MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Westhills Elementary1351 W Ellington Pkwy LewisburgTN
CHC24149-15ActiveBPS-H80-021603MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co High School597 W Ellington Pkwy LewisburgTN
CHC24149-16ActiveBPS-H80-022253MERCY HEALTH SERVICES, INC.Mercy office at Marshall Elementary School401 Tiger Blvd LewisburgTN
CHC24149-17ActiveBPS-H80-021602MERCY HEALTH SERVICES, INC.Mercy office at Marshall Co Lewisburg Middle school500 Tiger Blvd LewisburgTN
CHC24149-18ActiveBPS-H80-019468MERCY HEALTH SERVICES, INC.Mercy office at New Hope Academy1820 Downs Blvd FranklinTN
CHC24149-19ActiveBPS-H80-027502MERCY HEALTH SERVICES, INC.Mercy office at FSSD Johnson Elementary School815 Glass Ln FranklinTN
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC24149-00AVITA PHARMACY 1060RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH 40 PENNWOOD PL STE 200
WARRENDALEPA15086-662501/01/2016 12/31/2020
CHC24149-00AVITA PHARMACY 1061PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH 163 PLEASANT ST
ATTLEBOROMA02703-245701/01/2016 12/31/2020
CHC24149-00CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD STE 1400
ST PETERSBURGFL33716-233810/01/2018 12/31/2019
CHC24149-00CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B 		SMYRNAGA30082-525010/01/2018 12/31/2019
CHC24149-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CHC24149-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CHC24149-12CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2025  
CHC24149-00KENTUCKY CENTRAL FILL FACILITY, L-0105594 SHEPHERDSVILLE ROAD
LOUISVILLEKY40228-101204/01/2020 12/31/2021
CHC24149-00Kroger PharmacyJeffersonville Central Fill Facility 301 Logistics Ave
Suite 200 		JeffersonvilleIN4713002/03/2025  
CHC24149-00KROGER PHARMACY L-534301 SOUTH ELLINGTON PARKWAY
LEWISBURGTN3709102/03/2025  
CHC24149-00KROGER PHARMACY L-576595 HILLSBORO RD SUITE 305
FRANKLINTN3706404/01/2020 12/31/2021
CHC24149-00KROGER PHARMACY L-576595 HILLSBORO RD SUITE 305
FRANKLINTN3706402/03/2025  
CHC24149-00KROGER PHARMACY L-5921203 MURFREESBORO ROAD
FRANKLINTN3706404/01/2020 12/31/2021
CHC24149-00PHARMBLUE LLC DBA AVITA PHARMACY 10591226 CHESTNUT ST
PHILADELPHIAPA1910701/01/2016 12/31/2020
CHC24149-00PHARMBLUE TENNESSEE LLC1113 MURFREESBORO ROAD SUITE 319B
FRANKLINTN37064-130601/01/2017 12/31/2020
CHC24149-00PUBLIX SUPER MARKETS, INC.PUBLIX CENTRAL PHARMACY #3201 2424 ORLANDO CENTRAL PARKWAY
ORLANDOFL3280904/01/2020 12/31/2021
CHC24149-00PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #3213 1950 SAND LAKE RD, BLDG #5
ORLANDOFL3280904/01/2020 12/31/2021
CHC24149-00PUBLIX TENNESSEEPUBLIX PHARMACY #176 FRANKLIN MARKETPLACE
1021 RIVERSIDE DRIVE 		FRANKLINTN3706404/01/2020 12/31/2021
CHC24149-00PUBLIX TENNESSEE, LLCPUBILX PHARMACY #1529 5021 HUGHES CROSSING BLVD
FRANKLINTN3706404/01/2020 12/31/2021
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 386 4805 COLUMBIA PIKE
THOMPSON STATIONTN3717907/01/2022  
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06399 101 FARRIER LANE
FRANKLINTN3706407/01/2022  
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06415 1154 LIBERTY PIKE
FRANKLINTN3706707/01/2022  
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07099 9101 CAROTHERS PARKWAY
FRANKLINTN3706707/01/2022  
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.CVS PHARMACY # 17426 1033 CROSSINGS BLVD
SPRING HILLTN3717401/01/2023  
CHC24149-02TENNESSEE CVS PHARMACY, L.L.C.CVS PHARMACY # 17426 1033 CROSSINGS BLVD
SPRING HILLTN3717401/01/2024  
CHC24149-00TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06421 814 NASHVILLE HIGHWAY
COLUMBIATN3840110/01/2024  
CHC24149-14TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06415 1154 LIBERTY PIKE
FRANKLINTN3706701/01/2025  
CHC24149-06TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 386 4805 COLUMBIA PIKE
THOMPSON STATIONTN3717901/01/2025  
CHC24149-04TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07099 9101 CAROTHERS PARKWAY
FRANKLINTN3706701/01/2025  
CHC24149-00THE MEDICINE SHOPPE5225 WILSON LANE
MECHANICSBURGPA1705504/01/2015 12/31/2019
CHC24149-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2022  
CHC24149-00WAL-MART PHARMACY 10-01922200 BROOKMEADE DRIVE
COLUMBIATN3840102/03/2025  
CHC24149-00WAL-MART PHARMACY 10-02723600 MALLORY LANE
FRANKLINTN3706701/01/2022  
CHC24149-19WAL-MART PHARMACY 10-02723600 MALLORY LANE
FRANKLINTN3706701/01/2025  
CHC24149-00WAL-MART PHARMACY 10-03082518 HILLSBORO BLVD.
MANCHESTERTN3735501/01/2022  
CHC24149-00WAL-MART PHARMACY 10-06561880 N. MAIN ST
SHELBYVILLETN3716002/03/2025  
CHC24149-00WAL-MART PHARMACY 10-06672111 N JACKSON ST
TULLAHOMATN3738801/01/2022  
CHC24149-00WAL-MART PHARMACY 10-07371334 NO. ELLINGTON PARKWAY
LEWISBURGTN3709102/03/2025  
CHC24149-00WAL-MART PHARMACY 10-09831210 GIANT DRIVE
BLUE EARTHMN5601302/03/2025  
CHC24149-00WAL-MART PHARMACY 10-27444900 ROGERS AVENUE SUITE 101J
FORT SMITHAR7290301/01/2022  
CHC24149-00WAL-MART PHARMACY 10-51195531 EDMONDSON PIKE
NASHVILLETN3721101/01/2022  
CHC24149-13WAL-MART PHARMACY 10-51195531 EDMONDSON PIKE
NASHVILLETN3721101/01/2025  
CHC24149-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 01989 4932 MAIN STREET
SPRING HILLTN37174-826204/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04346 7601 HWY 70 S
NASHVILLETN3722104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04695 2045 FIELDSTONE PKWY
FRANKLINTN3706904/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04710 1509 MURFREESBORO RD
FRANKLINTN3706704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04872 5555 EDMONSON PIKE
NASHVILLETN3721104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04903 530 COOL SPRINGS BLVD.
FRANKLINTN3706704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS #04904 2611 8TH AVE S
NASHVILLETN37204-248304/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 05166 4243 HARDING PIKE
NASHVILLETN3720504/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 05564 2 MATHIS DRIVE
DICKSONTN3705504/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06277 2401 OLD FORT PARKWAY
MURFREESBOROTN3712804/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06409 101 FRANKLIN RD
BRENTWOODTN3702704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07494 1008 CENTER POINT PLACE
FRANKLINTN3706404/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07518 1451 NEW HWY 96 WEST
FRANKLINTN37064-482404/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07535 8110 HWY 100
NASHVILLETN37221-421404/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07659 1202 S JAMES CAMPBELL BLVD
COLUMBIATN3840104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS #09907 6815 NOLENSVILLE RD.
BRENTWOODTN3702704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09945 826 N MAIN ST
SHELBYVILLETN37160-284504/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 10191 1619 FRANKLIN RD
BRENTWOODTN37027-683304/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 10657 1081 MURFREESBORO PIKE
NASHVILLETN3721704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS #12273 4870 PORT ROYAL RD.
SPRING HILLTN3717404/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 13929 2819 NOLENSVILLE PIKE
NASHVILLETN3721104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09265 805 NASHVILLE HWY
COLUMBIATN38401-243104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09266 620 W COLLEGE ST
PULASKITN38478-361304/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04905 1131 DOCTOR MARTIN LUTHER KING JR BLVD
MURFREESBOROTN3713004/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06910 3010 S CHURCH STREET
MURFREESBOROTN3712704/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09444 312 E GAINES STREET
LAWRENCEBURGTN38464-353204/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09510 758 ELLINGTON PKWY
LEWISBURGTN3709104/01/2013 12/31/2016
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04158 3901 HILLSBORO PIKE
NASHVILLETN3721501/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06105 9100 CAROTHERS PKWY
FRANKLINTN3706701/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09778 1804 CHARLOTTE AVE
NASHVILLETN37203-210501/01/2019  
CHC24149-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21215 309C 22ND AVE N
NASHVILLETN3720301/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 01989 4932 MAIN STREET
SPRING HILLTN37174-826201/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04695 2045 FIELDSTONE PKWY
FRANKLINTN3706901/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04710 1509 MURFREESBORO RD
FRANKLINTN3706701/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04903 530 COOL SPRINGS BLVD.
FRANKLINTN3706701/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07494 1008 CENTER POINT PLACE
FRANKLINTN3706401/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07518 1451 NEW HWY 96 WEST
FRANKLINTN37064-482401/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS #12273 4870 PORT ROYAL RD.
SPRING HILLTN3717401/01/2019  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09510 758 ELLINGTON PKWY
LEWISBURGTN3709104/01/2020  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 03221 627 GALLATIN PIKE S
MADISONTN3711501/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 03451 5429 NOLENSVILLE RD
NASHVILLETN3721101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 03953 106 W NORTHFIELD
MURFREESBOROTN3712901/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04346 7601 HWY 70 S
NASHVILLETN3722101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04677 2244 MURFREESBORO PIKE
NASHVILLETN3721701/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04707 5600 CHARLOTTE PIKE
NASHVILLETN3720901/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 04872 5555 EDMONSON PIKE
NASHVILLETN3721101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07659 1202 S JAMES CAMPBELL BLVD
COLUMBIATN3840101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09265 805 NASHVILLE HWY
COLUMBIATN38401-243101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09546 4201 NOLENSVILLE PIKE
NASHVILLETN3721101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS #09907 6815 NOLENSVILLE RD.
BRENTWOODTN3702701/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 09945 826 N MAIN ST
SHELBYVILLETN37160-284501/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS #12375 1300 HAZELWOOD DR.
SMYRNATN3716701/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 10191 1619 FRANKLIN RD
BRENTWOODTN37027-683301/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 13929 2819 NOLENSVILLE PIKE
NASHVILLETN3721101/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 05028 3500 GALLATIN PIKE
NASHVILLETN3721604/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06211 1809 ANTIOCH PIKE
ANTIOCHTN37013-331104/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06693 3389 MEMORIAL BLVD
MURFREESBOROTN37129-525704/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06853 2421 LEBANON PIKE
NASHVILLETN37214-241204/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07316 3880 DICKERSON PIKE
NASHVILLETN3720704/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07689 2500 GALLATIN AVENUE
NASHVILLETN37206-321604/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS #12514 2006 MEDICAL CENTER PKWY.
MURFREESBOROTN3712904/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07076 1301 BELL ROAD
ANTIOCHTN37013-373004/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 06277 2401 OLD FORT PARKWAY
MURFREESBOROTN3712804/01/2022  
CHC24149-00WALGREEN CO.DBA: WALGREENS # 07535 8110 HWY 100
NASHVILLETN37221-421404/01/2022  
CHC24149-03WALGREEN CO.DBA: WALGREENS # 04710 1509 MURFREESBORO RD
FRANKLINTN3706701/01/2025  
CHC24149-15WALGREEN CO.DBA: WALGREENS # 07494 1008 CENTER POINT PLACE
FRANKLINTN3706401/01/2025  
CHC24149-05WALGREEN CO.DBA: WALGREENS # 01989 4932 MAIN STREET
SPRING HILLTN37174-826201/01/2025  
CHC24149-16WALGREEN CO.DBA: WALGREENS # 09510 758 ELLINGTON PKWY
LEWISBURGTN3709101/01/2025  
CHC24149-18WALGREEN CO.DBA: WALGREENS # 07659 1202 S JAMES CAMPBELL BLVD
COLUMBIATN3840101/01/2025  
CHC24149-10WALGREEN CO.DBA: WALGREENS #09907 6815 NOLENSVILLE RD.
BRENTWOODTN3702701/01/2025  
CHC24149-08WALGREEN CO.DBA: WALGREENS # 06105 9100 CAROTHERS PKWY
FRANKLINTN3706701/01/2025  
CHC24149-00Walgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101 		MemphisTN3811807/01/2022  
CHC24149-00WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2013 08/10/2015
CHC24149-00WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904904/01/2013 08/10/2015
CHC24149-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/01/2023  
CHC24149-00WALMART PHARMACY #10-30174959 MAIN STREET
SPRING HILLTN3717401/01/2022  
CHC24149-17WALMART PHARMACY #10-30174959 MAIN STREET
SPRING HILLTN3717401/01/2025  
CHC24149-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CHC24149-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification 2/21/2025 10:25:25 AM2/21/2025 10:25 AM
DetailsStateUpdate ApprovedActive1/1/2025 12:01 AM
ContactsSigned ByInsertNew Registration Sizemore, Rhonda CFO Mercy Community Healthcare 6157900567-20611/12/2024 7:40 AM
Details340B IDUpdateNew Registration CHC24149-0511/12/2024 7:40 AM
DatesParticipating Approval DateUpdateNew Registration 11/12/2024 7:40:37 AM11/12/2024 7:40 AM
DetailsStateUpdateNew RegistrationPendingApproved11/12/2024 7:40 AM
DatesSigned By DateUpdateNew Registration 11/7/2024 11:26:12 AM11/12/2024 7:40 AM
DatesStart DateUpdateNew Registration 1/1/2025 12:00:00 AM11/12/2024 7:40 AM
AddressesMain AddressInsertNew Registration  1645 Franklin Pike Lewisburg, TN 37091-691611/7/2024 10:46 AM
AddressesBilling AddressInsertNew Registration Mercy Health Services, Inc. 143 SE Parkway Ct Franklin, TN 3706411/7/2024 10:46 AM
ContactsAuthorizing OfficialInsertNew Registration Sizemore, Rhonda CFO Mercy Community Healthcare 6157900567-20611/7/2024 10:46 AM
ContactsPrimary ContactInsertNew Registration Irvin, Martha M Controller Mercy Community Healthcare 6157900567-610111/7/2024 10:46 AM
DetailsAssistance Received From DateInsertNew Registration  11/7/2024 10:46 AM
DetailsAssistance Received To DateInsertNew Registration  11/7/2024 10:46 AM
DetailsLast Recertification DateInsertNew Registration  11/7/2024 10:46 AM
DetailsGrant NumberInsertNew Registration H80CS2414911/7/2024 10:46 AM
Details340B IDInsertNew Registration  11/7/2024 10:46 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  11/7/2024 10:46 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  11/7/2024 10:46 AM
DetailsMedicare Provider NumberInsertNew Registration  11/7/2024 10:46 AM
DetailsEntity NameInsertNew Registration MERCY HEALTH SERVICES, INC.11/7/2024 10:46 AM
DetailsNOFO NumberInsertNew Registration  11/7/2024 10:46 AM
DetailsProgram CodeInsertNew Registration CH11/7/2024 10:46 AM
DetailsEntity SubnameInsertNew Registration Mercy office at Marshall Co Oak Grove Elementary11/7/2024 10:46 AM
DatesParticipating Approval DateInsertNew Registration  11/7/2024 10:46 AM
DetailsStateInsertNew Registration Pending11/7/2024 10:46 AM
DatesRegistration DateInsertNew Registration 11/7/2024 10:46:35 AM11/7/2024 10:46 AM
DatesSigned By DateInsertNew Registration  11/7/2024 10:46 AM
DatesStart DateInsertNew Registration  11/7/2024 10:46 AM
TerminationsTermination CommentsInsertNew Registration  11/7/2024 10:46 AM
TerminationsTermination DateInsertNew Registration  11/7/2024 10:46 AM
TerminationsTermination Effective DateInsertNew Registration  11/7/2024 10:46 AM
TerminationsTermination ReasonInsertNew Registration  11/7/2024 10:46 AM