Covered Entity Details

CH041309I Cherokee Health Systems (Active) - information as of 5/3/2025 11:27:30 PM

Main Details

Name

Cherokee Health Systems

Subdivision Name

CHS Maynardville Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005350

340B ID

CH041309I

Grant Number

H80CS00309

Additional Details

Current Program Status

Active

Registration Date

7/1/2005

Participating Start Date

7/1/2005

Participating Approval Date

5/16/2005

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Cherokee Health Systems
Suzanne Bailey, Chief Operating Officer
(865) 544-0406

Primary Contact

Cherokee Health Systems
NEIL LAWLEY, Pharmacy Operations Manager
(865) 544-0406

Addresses

Street Address

4330 Maynardville Hwy
Maynardville, TN 37807-3618

Billing Address

Cherokee Health Systems
6350 W. Andrew Johnson Hwy
Talbott, TN 37877

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
NEW SITE 07/01/2005; 6/23/06 - ADDED SHIPPING ADDRESS	06/23/2006

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TN	3686393,0441846	1134128820,1487891594

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS #18021	2710 MAYNARDVILLE HIGHWAY	MAYNARDVILLE	TN	37807	04/12/2024	07/01/2024			07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH0413090	Active	BPS-H80-001798	Cherokee Health Systems	CHS Talbott Clinic	6350 W Andrew Johnson Hwy		Talbott	TN
CH041309AB	Terminated	BPS-H80-003299	CHEROKEE HEALTH SYSTEMS	WEST KNOX HEALTH CENTER	10263 Kingston Pike		Knoxville	TN
CH041309AC	Active	BPS-H80-010635	Cherokee Health Systems	CHS Alcoa (Blount Co)	255 E Watt St		Alcoa	TN
CH041309AD	Active	BPS-H80-010177	Cherokee Health Systems	CHS Wearwood Elementary School Clinic	3150 Wearwood Dr		Sevierville	TN
CH041309AE	Active	BPS-H80-010186	Cherokee Health Systems	CHS Seymour Primary School Clinic	717 Boyds Creek Road		Seymour	TN
CH041309AF	Active	BPS-H80-010179	Cherokee Health Systems	CHS Seymour Middle School Clinic	737 Boyds Creek Rd		Seymour	TN
CH041309AG	Active	BPS-H80-010192	Cherokee Health Systems	CHS Seymour Intermediate School	212 N Pitner Rd		Seymour	TN
CH041309AH	Active	BPS-H80-010188	Cherokee Health Systems	CHS Sevierville Primary School Clinic	1146 Blanton Dr		Sevierville	TN
CH041309AJ	Active	BPS-H80-010176	Cherokee Health Systems	CHS Sevierville Middle School Clinic	520 High St		Sevierville	TN
CH041309AK	Active	BPS-H80-010184	CHEROKEE HEALTH SYSTEMS	CHS Sevierville Intermediate School Clinic	416 High St		Sevierville	TN
CH041309AL	Active	BPS-H80-010183	Cherokee Health Systems	CHS Pittman Center Elementary School Clinic	2455 E Parkway		Gatlinburg	TN
CH041309AM	Active	BPS-H80-010190	Cherokee Health Systems	CHS Pigeon Forge Primary School Clinic	1766 Waldens Creek Road		Pigeon Forge	TN
CH041309AN	Active	BPS-H80-010181	Cherokee Health Systems	CHS Pigeon Forge Middle School Clinic	300 Wears Valley Rd		Pigeon Forge	TN
CH041309AP	Active	BPS-H80-010178	Cherokee Health Systems	CHS Pi Beta Phi Elementary School Clinic	125 Cherokee Orchard Rd		Gatlinburg	TN
CH041309AQ	Active	BPS-H80-010182	Cherokee Health Systems	CHS Northview Middle School Clinic	3295 Douglas Dam Rd.		Kodak	TN
CH041309AR	Active	BPS-H80-010191	Cherokee Health Systems	CHS Northview Primary School Clinic	3293 Douglas Dam Rd		Kodak	TN
CH041309AS	Active	BPS-H80-010187	Cherokee Health Systems	CHS New Center Elementary School Clinic	2701 Old Newport Hwy		Sevierville	TN
CH041309AT	Active	BPS-H80-010174	Cherokee Health Systems	CHS Jones Cove Elementary School Clinic	4554 Jones Cove Rd		Cosby	TN
CH041309AU	Active	BPS-H80-010189	Cherokee Health Systems	CHS Catlettsburg Elementary School Clinic	1409 Catlettsburg Rd		Sevierville	TN
CH041309AV	Active	BPS-H80-010175	Cherokee Health Systems	CHS Catons Chapel Elementary School Clinic	3135 Catons Chapel Rd		Sevierville	TN
CH041309AW	Active	BPS-H80-010180	Cherokee Health Systems	CHS Boyd Creek Elementary School Clinic	1729 Indian Warpath		Sevierville	TN
CH041309AX	Terminated	BPS-H80-010661	CHEROKEE HEALTH SYSTEMS	CHS Rutledge Middle School Clinic	150 Pioneer Dr		Rutledge	TN
CH041309AY	Active	BPS-H80-011830	Cherokee Health Systems	CHS East Knox Clinic	2202 Martin Luther King Jr Ave		Knoxville	TN
CH041309AZ	Terminated	BPS-H80-010851	CHEROKEE HEALTH SYSTEMS	CHS Newport Grammar School Clinic	320 8th Steet		Newport	TN
CH041309BA	Active	BPS-H80-008620	Cherokee Health Systems	CHS New Tazewell Clinic (Claiborne County)	1596 Highway 33 S		New Tazewell	TN
CH041309BB	Active	BPS-H80-011370	Cherokee Health Systems	CHS Knox Homeless Health Center (5th Ave)	538 W 5th Ave		Knoxville	TN
CH041309BC	Active	BPS-H80-013381	Cherokee Health Systems	CHS Loudon County	501 Adesa Blvd	Ste A150	Lenoir City	TN
CH041309BD	Active	BPS-H80-038334	Cherokee Health Systems	CHS Clinton Clinic (Anderson County)	165 Frank L Diggs Dr		Clinton	TN
CH041309BE	Active	BPS-H80-014585	Cherokee Health Systems	CHS Newport Clinic	215 Hedrick Dr		Newport	TN
CH041309BF	Active	BPS-H80-022021	Cherokee Health Systems	CHS Chattanooga	5600 Brainerd Rd Ste A4		Chattanooga	TN
CH041309BG	Terminated	BPS-H80-031114	CHEROKEE HEALTH SYSTEMS	CHS - Frayser	2146 Frayser Blvd		Memphis	TN
CH041309BH	Terminated	BPS-H80-019514	CHEROKEE HEALTH SYSTEMS	CHS - Whitehaven	5339 Elvis Presley Blvd.		Memphis	TN
CH041309BJ	Terminated	BPS-H80-019511	CHEROKEE HEALTH SYSTEMS	CHS American Way	4095 American Way, Suite 1		Memphis	TN
CH041309BK	Terminated	BPS-H80-030020	CHEROKEE HEALTH SYSTEMS	CHS Parkway Village	4095 American Way, Suite 1		Memphis	TN
CH041309BL	Active	BPS-H80-030039	Cherokee Health Systems	CHS Lonsdale	1754 Texas Ave		Knoxville	TN
CH041309BM	Active	BPS-H80-030937	Cherokee Health Systems	CHS Mobile Van 1	6350 W Andrew Johnson Hwy		Talbott	TN
CH041309BN	Active	BPS-H80-033938	Cherokee Health Systems	CHS Cherokee Mills	2240 Sutherland Ave Ste 103		Knoxville	TN
CH041309BP	Terminated	BPS-H80-017198	CHEROKEE HEALTH SYSTEMS	CHS Clairfield	5619 Highway 90		Clairfield	TN
CH041309BQ	Active	BPS-H80-038926	CHEROKEE HEALTH SYSTEMS	CHS Oakwood	1515 Saint Mary Street STE B		Knoxville	TN
CH041309BR	Active	BPS-H80-038988	CHEROKEE HEALTH SYSTEMS	CHS Mobile Unit 2	6350 W Andrew Johnson Hwy		Talbott	TN
CH041309C	Active	BPS-H80-024731	Cherokee Health Systems	CHS Blaine Clinic	880 Rutledge Pike		Blaine	TN
CH041309D	Terminated	BPS-H80-002252	CHEROKEE HEALTH SYSTEMS	BEAN STATION HEALTH CENTER	1285 Highway 11w		Bean Station	TN
CH041309E	Active	BPS-H80-015049	Cherokee Health Systems	CHS Seymour Clinic (Sevier County)	10731 Chapman Hwy		Seymour	TN
CH041309F	Active	BPS-H80-000490	Cherokee Health Systems	CHS Washburn Clinic	7719 Highway 131		Washburn	TN
CH041309I	Active	BPS-H80-005350	Cherokee Health Systems	CHS Maynardville Clinic	4330 Maynardville Hwy		Maynardville	TN
CH041309J	Active	BPS-H80-005282	CHEROKEE HEALTH SYSTEMS	CHS 5th Street Clinic	815 W 5th North St		Morristown	TN
CH041309L	Terminated	BPS-H80-007853	CHEROKEE HEALTH SYSTEMS	CHS Jefferson County Clinic	120 Hospital Drive STE 230		Jefferson City	TN
CH041309N	Active	BPS-H80-004838	Cherokee Health Systems	CHS North Knox Clinic	7714 Conner Rd Ste 105		Powell	TN
CH041309P	Active	BPS-H80-003255	Cherokee Health Systems	CHS Center City Clinic	2018 Western Ave		Knoxville	TN
CH041309U	Active	BPS-H80-010633	Cherokee Health Systems	CHS Englewood Clinic	3360 Highway 411 N		Englewood	TN
CH041309V	Terminated	BPS-H80-010505	CHEROKEE HEALTH SYSTEMS	CHS Dameron Avenue Clinic	140 Dameron Ave		Knoxville	TN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0413090	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2023
CH0413090	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2023
CH0413090	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2023
CH0413090	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2023
CH0413090	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023
CH0413090	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2023
CH0413090	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2023
CH041309BQ	BELEW DRUG	2021 N BROADWAY ST		KNOXVILLE	TN	37917	04/01/2025
CH0413090	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2023
CH0413090	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2023
CH0413090	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2023
CH0413090	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2023
CH0413090	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2023
CH0413090	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2023
CH0413090	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2023
CH0413090	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2023
CH0413090	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2023
CH0413090	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2023
CH0413090	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2023
CH0413090	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2023
CH0413090	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2023
CH0413090	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2022
CH0413090	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023
CH0413090	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023
CH0413090	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023
CH0413090	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023
CH0413090	FOOD CITY PHARMACY #619	180 RUTLEDGE PIKE		BLAINE	TN	37709	01/01/2024	07/02/2024
CH0413090	FOOD CITY PHARMACY #680	4344 MAYNARDVILLE HWY		MAYNARDVILLE	TN	37807	07/01/2017	07/02/2024
CH041309U	FOOD CITY PHARMACY #680	4344 MAYNARDVILLE HWY		MAYNARDVILLE	TN	37807	07/01/2024
CH0413090	HEALTHCARE	CLINTON DRUG STORE	1130 N CHARLES G SEIVERS BLVD BLVD.	CLINTON	TN	37716-3937	10/01/2014
CH0413090	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	07/01/2022	05/11/2023
CH0413090	K-VA-T FOOD STORES INC	DBA FOOD CITY PHARMACY #618	1212 STATE STREET	WHITE PINE	TN	37890	07/01/2017	07/02/2024
CH0413090	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	04/01/2019	10/10/2022
CH0413090	KROGER #558	4414 ASHVILLE HIGHWAY		KNOXVILLE	TN	37914	04/01/2019
CH0413090	KROGER DRUGSTORE #549	6702 CLINTON HWY		KNOXVILLE	TN	37912	10/01/2013
CH0413090	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	04/01/2023
CH0413090	KROGER PHARMACY #506	2217 BROADWAY		KNOXVILLE	TN	37917	10/01/2013
CH0413090	KROGER PHARMACY #531	4409 CHAPMAN HWY		KNOXVILLE	TN	37920	04/01/2019
CH0413090	KROGER PHARMACY #562	702 WINFIELD DUNN PKWY		SEVIERVILLE	TN	37876	01/01/2025
CH0413090	KROGER PHARMACY #581	10721 CHAPMAN HIGHWAY		SEYMOUR	TN	37865	10/01/2013
CH0413090	KROGER PHARMACY #684	9225 KINGSTON RD		KNOXVILLE	TN	37922	10/01/2013
CH0413090	OKIES PHARMACY	1050 RUTLEDGE PIKE	PO BOX 39	BLAINE	TN	37709	07/01/2024
CH0413090	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	10/01/2024
CH0413090	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH0413090	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CH0413090	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2022	08/31/2022
CH0413090	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2023
CH0413090	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #11188	979 EAST THIRD STREET, STE 120	CHATTANOOGA	TN	37403	07/01/2022	02/28/2025
CH0413090	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2023
CH0413090	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2023
CH0413090	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2023
CH0413090	RITE AID OF TENNESSEE, INC.	RITE AID #3418	1255 HIGHWAY 11 WEST	BEAN STATION	TN	37708	07/01/2017	12/14/2017
CH0413090	RITE AID OF TENNESSEE, INC.	RITE AID #1050	915 MAIN STREET	TAZEWELL	TN	37825	07/01/2017	12/14/2017
CH0413090	RITE AID OF TENNESSEE, INC.	RITE AID #3576	922 SOUTH CUMBERLAND ST	MORRISTOWN	TN	37813	07/01/2017	12/14/2017
CH0413090	RITE AID OF TENNESSEE, INC.	RITE AID #3391	2710 MAYNARDVILLE HIGHWAY	MAYNARDSVILLE	TN	37807	07/01/2017	12/14/2017
CH041309BR	SEYMOUR ADVALUE PHARMACY	10721 CHAPMAN HWY STE 6		SEYMOUR	TN	37865-4771	04/01/2025
CH0413090	TAZEWELL DRUG AND HEALTH INC	951 N BROAD ST		TAZEWELL	TN	37879-4323	01/01/2025
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07226	2114 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814	07/01/2017
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03741	4500 E. EMORY ROAD	KNOXVILLE	TN	37938	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03735	5501 BRAINERD ROAD	CHATTANOOGA	TN	37411	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07246	346 COSBY HIGHWAY	NEWPORT	TN	37821	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05671	103 FOOTHILLS MALL DR.	MARYVILLE	TN	37801	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03769	139 E. BROADWAY BLVD.	JEFFERSON CITY	TN	37760	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06364	5401 CLINTON HIGHWAY	KNOXVILLE	TN	37912	07/01/2022	12/05/2024
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04457	7341 TAZEWELL PIKE	CORRYTON	TN	37721	07/01/2022	08/07/2024
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06365	101 N. CHARLES G SEIVERS BLVD.	CLINTON	TN	37716	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04928	5055 STAGE RD.	MEMPHIS	TN	38128	07/01/2022	03/25/2025
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03743	110 MAJESTIC GROVE RD	KNOXVILLE	TN	37920	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06355	4325 ASHEVILLE HIGHWAY E.	KNOXVILLE	TN	37914	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03727	2008 W. ANDREW JOHNSON HWY	MORRISTOWN	TN	37814	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05601	570 HIGHWAY 321 NORTH	LENOIR CITY	TN	37771	07/01/2022
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06359	111 S. HALL RD.	ALCOA	TN	37701	10/01/2023
CH041309AF	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05601	570 HIGHWAY 321 NORTH	LENOIR CITY	TN	37771	07/01/2024
CH041309AL	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03741	4500 E. EMORY ROAD	KNOXVILLE	TN	37938	07/01/2024
CH041309BD	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06365	101 N. CHARLES G SEIVERS BLVD.	CLINTON	TN	37716	07/01/2024
CH041309AT	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07226	2114 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814	07/01/2024
CH041309AU	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04457	7341 TAZEWELL PIKE	CORRYTON	TN	37721	07/01/2024
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03721	4864 BROADWAY ST	KNOXVILLE	TN	37918	07/01/2025
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03762	9175 KINGSTON PIKE	KNOXVILLE	TN	37923	07/01/2025
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02404	417 E EMORY RD	POWELL	TN	37849-3518	07/01/2025
CH0413090	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06363	6005 KINGSTON PIKE	KNOXVILLE	TN	37919	07/01/2025
CH0413090	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH0413090	WAL-MART PHARMACY 10-0672	1030 HUNTERS CROSSING DRIVE		ALCOA	TN	37701	04/01/2022
CH0413090	WAL-MART PHARMACY 10-0678	1075 COSBY HIGHWAY		NEWPORT	TN	37821	04/01/2022
CH041309AK	WAL-MART PHARMACY 10-0678	1075 COSBY HIGHWAY		NEWPORT	TN	37821	07/01/2024
CH0413090	WAL-MART PHARMACY 10-0685	475 SO. DAVY CROCKETT PKWY.		MORRISTOWN	TN	37813	07/01/2020
CH041309F	WAL-MART PHARMACY 10-0685	475 SO. DAVY CROCKETT PKWY.		MORRISTOWN	TN	37813	07/01/2024
CH0413090	WAL-MART PHARMACY 10-0724	630 E BROADWAY		JEFFERSON CITY	TN	37760	07/01/2020
CH041309AV	WAL-MART PHARMACY 10-0724	630 E BROADWAY		JEFFERSON CITY	TN	37760	07/01/2024
CH0413090	WAL-MART PHARMACY 10-0741	911 HWY 321 NORTH		LENOIR CITY	TN	37771	04/01/2019
CH0413090	WAL-MART PHARMACY 10-1159	432 S BROAD STREET		NEW TAZEWELL	TN	37825	04/01/2019
CH041309BF	WAL-MART PHARMACY 10-1159	432 S BROAD STREET		NEW TAZEWELL	TN	37825	07/01/2024
CH0413090	WAL-MART PHARMACY 10-1318	6777 CLINTON HWY		KNOXVILLE (NW)	TN	37912	07/01/2014
CH0413090	WAL-MART PHARMACY 10-1319	7550 NORRIS FREEWAY		KNOXVILLE	TN	37938	07/01/2014
CH041309AM	WAL-MART PHARMACY 10-1319	7550 NORRIS FREEWAY		KNOXVILLE	TN	37938	07/01/2024
CH0413090	WAL-MART PHARMACY 10-1320	7420 CHAPMAN HWY		KNOXVILLE (SE)	TN	37920	04/01/2019
CH0413090	WAL-MART PHARMACY 10-2065	8445 WALBROOK DRIVE		KNOXVILLE (W)	TN	37923	07/01/2020
CH0413090	WAL-MART PHARMACY 10-2310	3051 KLNZEL WAY		KNOXVILLE (E)	TN	37924	07/01/2014
CH041309BB	WAL-MART PHARMACY 10-2310	3051 KLNZEL WAY		KNOXVILLE (E)	TN	37924	07/01/2024
CH0413090	WAL-MART PHARMACY 10-4223	2410 US HIGHWAY 411 S		MARYVILLE	TN	37801	10/01/2023
CH0413090	WAL-MART PHARMACY 10-4635	150 TANNER LANE		CLINTON	TN	37716	10/01/2023
CH0413090	WAL-MART PHARMACY 10-5251	490 GREENWAY VIEW DR		CHATTANOOGA	TN	37411	04/01/2019
CH0413090	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2024
CH0413090	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #11435	915 N. BROAD ST.	NEW TAZEWELL	TN	37825-6633	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 07407	11305 CHAPMAN HWY	SEYMOUR	TN	37865-4811	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05502	350 HWY 321 N	LENOIR CITY	TN	37771	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 09430	132 E BROADWAY BLVD	JEFFERSON CITY	TN	37760-2535	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 07406	245 S MAIN STREET	CLINTON	TN	37716-3603	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 04169	4001 CHAPMAN HIGHWAY	KNOXVILLE	TN	37920	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 06788	1959 W ANDREW JOHNSON HWY	MORRISTOWN	TN	37814	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03798	2400 NORTH BROADWAY	KNOXVILLE	TN	37917	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 07320	7320 CLINTON HIGHWAY	POWELL	TN	37849-5205	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 06224	5320 CLINTON HWY	KNOXVILLE	TN	37912	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05394	6920 MAYNARDVILLE PIKE	KNOXVILLE	TN	37918	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05373	5006 N BROADWAY STREET	KNOXVILLE	TN	37918	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS #11813	251 S CUMBERLAND ST	MORRISTOWN	TN	37813	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05729	9200 MIDDLEBROOK PIKE	KNOXVILLE	TN	37931	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS #12311	2151 N. CHARLES G. SEIVERS BLVD.	CLINTON	TN	37716	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03209	8950 KINGSTON PIKE	KNOXVILLE	TN	37923	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #12858	2103 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814-5411	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS #11174	7400 CHAPMAN HWY.	KNOXVILLE	TN	37920-6614	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 04330	121 N. NORTHSHORE DRIVE	KNOXVILLE	TN	37919	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03137	1299 OAK RIDGE TURNPIKE	OAK RIDGE	TN	37830	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03353	2514 MAGNOLIA AVE	KNOXVILLE	TN	37914	12/06/2011	08/27/2015
CH0413090	WALGREEN CO.	DBA: WALGREENS # 10164	4440 HIGHWAY411	MADISONVILLE	TN	37354-1563	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 07374	4423 WESTERN AVENUE	KNOXVILLE	TN	37921-4310	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03388	225 N HALL RD	ALCOA	TN	37701	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 06967	4423 ASHEVILLE HWY	KNOXVILLE	TN	37914-3604	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS #10066	929 NEW HWY. 68	SWEETWATER	TN	37874-2726	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS #12980	7425 TAZEWELL PIKE	CORRYTON	TN	37721	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05790	1302 S CONGRESS PARKWAY	ATHENS	TN	37303	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 01634	7810 OAK RIDGE HIGHWAY	KNOXVILLE	TN	37931-2313	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 06993	220 FOOTHILLS MALL DRIVE	MARYVILLE	TN	37801-5516	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05483	7523 KINGSTON PIKE	KNOXVILLE	TN	37919	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 09522	805 W MADISON AVE	ATHENS	TN	37303-3429	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 06609	119 FORKS OF THE RIVER PKWY	SEVIERVILLE	TN	37862	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 05053	601 N CAMPBELL STATION	FARRAGUT	TN	37934	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 04199	9536 S NORTHSHORE DR	KNOXVILLE	TN	37922	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03955	10701 KINGSTON PIKE	KNOXVILLE	TN	37934	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #12448	303 NEW RIVERSIDE DR.	SEVIERVILLE	TN	37862	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #10612	1797 ROANE STATE HWY.	HARRIMAN	TN	37748-8306	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 01015	1725 CUMBERLAND AVE	KNOXVILLE	TN	37916	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 10688	102 E BROADWAY	NEWPORT	TN	37821-2323	12/06/2011
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03284	1840 PARKWAY	SEVIERVILLE	TN	37862	12/06/2011	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS # 07048	3071 PARKWAY	PIGEON FORGE	TN	37863	12/06/2011
CH0413090	WALGREEN CO.		DBA: WALGREENS 101 ALLIANCE PARKWAY	WILLIAMSTON	SC	29697-9103	02/10/2012	06/18/2015
CH0413090	WALGREEN CO.	DBA: WALGREENS #10960	4325 HIGHWAY 66 S	ROGERSVILLE	TN	37857-3155	10/01/2014	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #11699	2409 US HWY. 411 S	MARYVILLE	TN	37801	10/01/2014	11/30/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #18021	2710 MAYNARDVILLE HIGHWAY	MAYNARDVILLE	TN	37807	03/01/2018
CH0413090	WALGREEN CO.	RITE AID #03576	922 SOUTH CUMBERLAND STREET	MORRISTOWN	TN	37814	03/01/2018	06/28/2018
CH0413090	WALGREEN CO.	RITE AID #01050	915 MAIN STREET	NEW TAZEWELL	TN	37825	03/01/2018	08/27/2018
CH0413090	WALGREEN CO.	DBA: WALGREENS #17569	1149 HIGHWAY 11W	BEAN STATION	TN	37708	03/01/2018
CH0413090	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15317	1424 UNION AVE	MEMPHIS	TN	38104	04/01/2020	10/06/2023
CH0413090	WALGREEN CO.	DBA: WALGREENS # 13108	2655 FRAYSER BLVD	MEMPHIS	TN	38127	01/01/2022	10/06/2023
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03538	3605 BRAINERD ROAD	CHATTANOOGA	TN	37411	07/01/2022
CH0413090	WALGREEN CO.	DBA: WALGREENS # 03537	5301 RINGGOLD RD	EAST RIDGE	TN	37412	04/01/2023
CH0413090	WALGREEN CO.	DBA: WALGREENS # 04084	4542 HIGHWAY 58	CHATTANOOGA	TN	37416	04/01/2023
CH041309AN	WALGREEN CO.	DBA: WALGREENS # 05373	5006 N BROADWAY STREET	KNOXVILLE	TN	37918	07/01/2024
CH041309AD	WALGREEN CO.	DBA: WALGREENS # 09430	132 E BROADWAY BLVD	JEFFERSON CITY	TN	37760-2535	07/01/2024
CH041309I	WALGREEN CO.	DBA: WALGREENS #18021	2710 MAYNARDVILLE HIGHWAY	MAYNARDVILLE	TN	37807	07/01/2024
CH041309AH	WALGREEN CO.	DBA: WALGREENS # 06993	220 FOOTHILLS MALL DRIVE	MARYVILLE	TN	37801-5516	07/01/2024
CH041309BN	WALGREEN CO.	DBA: WALGREENS # 03798	2400 NORTH BROADWAY	KNOXVILLE	TN	37917	07/01/2024
CH041309AQ	WALGREEN CO.	DBA: WALGREENS # 04169	4001 CHAPMAN HIGHWAY	KNOXVILLE	TN	37920	07/01/2024
CH041309AP	WALGREEN CO.	DBA: WALGREENS # 07374	4423 WESTERN AVENUE	KNOXVILLE	TN	37921-4310	07/01/2024
CH041309BM	WALGREEN CO.	DBA: WALGREENS #17569	1149 HIGHWAY 11W	BEAN STATION	TN	37708	07/01/2024
CH041309AJ	WALGREEN CO.	DBA: WALGREENS #11813	251 S CUMBERLAND ST	MORRISTOWN	TN	37813	07/01/2024
CH041309AS	WALGREEN CO.	DBA: WALGREENS # 06609	119 FORKS OF THE RIVER PKWY	SEVIERVILLE	TN	37862	07/01/2024
CH041309AG	WALGREEN CO.	DBA: WALGREENS # 05502	350 HWY 321 N	LENOIR CITY	TN	37771	07/01/2024
CH041309BE	WALGREEN CO.	DBA: WALGREENS # 10688	102 E BROADWAY	NEWPORT	TN	37821-2323	07/01/2024
CH041309AR	WALGREEN CO.	DBA: WALGREENS #12858	2103 E. ANDREW JOHNSON HWY.	MORRISTOWN	TN	37814-5411	07/01/2024
CH041309BA	WALGREEN CO.	DBA: WALGREENS #11435	915 N. BROAD ST.	NEW TAZEWELL	TN	37825-6633	07/01/2024
CH041309AY	WALGREEN CO.	DBA: WALGREENS # 06967	4423 ASHEVILLE HWY	KNOXVILLE	TN	37914-3604	07/01/2024
CH041309AW	WALGREEN CO.	DBA: WALGREENS # 03388	225 N HALL RD	ALCOA	TN	37701	07/01/2024
CH041309AE	WALGREEN CO.	DBA: WALGREENS # 07407	11305 CHAPMAN HWY	SEYMOUR	TN	37865-4811	07/01/2024
CH041309N	WALGREEN CO.	DBA: WALGREENS # 06224	5320 CLINTON HWY	KNOXVILLE	TN	37912	07/01/2024
CH041309E	WALGREEN CO.	DBA: WALGREENS # 03137	1299 OAK RIDGE TURNPIKE	OAK RIDGE	TN	37830	07/01/2024
CH041309C	WALGREEN CO.	DBA: WALGREENS # 06788	1959 W ANDREW JOHNSON HWY	MORRISTOWN	TN	37814	07/01/2024
CH041309BL	WALGREEN CO.	DBA: WALGREENS # 05394	6920 MAYNARDVILLE PIKE	KNOXVILLE	TN	37918	07/01/2024
CH0413090	WALGREEN CO.	DBA: WALGREENS #21264	4935 MILLERTOWN PIKE	KNOXVILLE	TN	37917	07/01/2025
CH0413090	WALGREEN CO.	DBA: WALGREENS # 10164	4440 HIGHWAY411	MADISONVILLE	TN	37354-1563	07/01/2025
CH0413090	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH0413090	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	06/18/2015
CH0413090	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	06/18/2015
CH0413090	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2022
CH0413090	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2022
CH0413090	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2022
CH0413090	WALMART PHARMACY #10-6370	4331 W. ANDREW JOHNSON HWY		MORRISTOWN	TN	37814	07/01/2020
CH0413090	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH0413090	WALMART PHARMACY 10-5467	1997 BUFFALO TRAIL		MORRISTOWN	TN	37814	04/01/2022
CH0413090	WALMART PHARMACY 10-5908	1185 DOLLY PARTON PKWY		SEVIERVILLE	TN	37862	10/01/2024
CH0413090	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	441846 (TN)		2/23/2025 5:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3686393	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0441846	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	2/23/2025 5:24 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	Q036968 (TN)		2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	Q036969 (TN)		2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3386393 (TN)		2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	Q067867 (TN)		2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		441846	2/18/2025 6:06 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	2/18/2025 6:06 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0441846 (TN)		2/18/2025 6:06 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1841397783 (TN)		2/18/2025 6:06 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1033781588 (TN)		2/18/2025 6:06 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760261044 (TN)		2/18/2025 6:06 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1881763126 (TN)		2/18/2025 6:06 AM
Details	Last Recertification Date	Update	Recertification	1/30/2024 12:25:13 PM	2/18/2025 6:06:36 AM	2/18/2025 6:06 AM
Details	Entity Name	Update	Recertification	CHEROKEE HEALTH SYSTEMS	Cherokee Health Systems	2/18/2025 6:06 AM
Details	Entity Subname	Update	Recertification	CHEROKEE HLTH SYSTEMS - MAYNARDV	CHS Maynardville Clinic	2/18/2025 6:06 AM
Addresses	Shipping Address	Delete	Change Request	Cherokee Health Systems 4330 Maynardville Hwy Maynardville, TN 37807-3618		12/20/2024 8:17 AM
Addresses	Shipping Address	Delete	Change Request	Cherokee Health Systems 255 E Watt St Alcoa, TN 37701		12/20/2024 8:17 AM
Addresses	Shipping Address	Delete	Change Request	Cherokee Health Systems 815 West 5th North Street Morristown, TN 37814		12/20/2024 8:17 AM
Addresses	Shipping Address	Delete	Change Request	Cherokee Health Systems 2018 Western Ave Knoxville, TN 37921		12/20/2024 8:17 AM
Addresses	Shipping Address	Delete	Change Request	Cherokee Health Systems 501 Adesa Blvd Suite A-150 Lenoir City, TN 37771		12/20/2024 8:17 AM
Contacts	Authorizing Official	Update	Group Change Request	Khatri, Parinda CEO Cherokee Health Systems 8655440406	Bailey, Suzanne Chief Operating Officer Cherokee Health Systems 8655440406	3/4/2024 11:33 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 12:13:38 PM	1/30/2024 12:25:13 PM	1/30/2024 12:25 PM
Addresses	Shipping Address	Insert	Group Change Request		Cherokee Health Systems 815 West 5th North Street Morristown, TN 37814	10/16/2023 5:03 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1760261044	10/16/2023 5:03 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	10/16/2023 5:03 PM
Contacts	Authorizing Official	Update	Group Change Request	Bailey, Suzanne Chief Operating Officer Cherokee Health Systems 8653107624	Khatri, Parinda CEO Cherokee Health Systems 8655440406	10/6/2023 1:49 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 8:31:01 AM	1/31/2023 12:13:38 PM	1/31/2023 12:13 PM
Contacts	Primary Contact	Update	Group Change Request	Clawson, Karen Pharmacy Director Cherokee Health Systems 8655440406-6727	LAWLEY, NEIL Pharmacy Operations Manager Cherokee Health Systems 8655440406	9/21/2022 12:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2022 8:31 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q067867	2/16/2022 8:31 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	2/16/2022 8:31 AM
Details	Last Recertification Date	Update	Recertification	2/16/2021 9:01:10 PM	2/16/2022 8:31:01 AM	2/16/2022 8:31 AM
Contacts	Authorizing Official	Update	AO Change Request	Howard, Jeffrey W CFO Cherokee Health Systems 8659346708	Bailey, Suzanne Chief Operating Officer Cherokee Health Systems 8653107624	2/7/2022 7:00 AM
Addresses	Shipping Address	Insert	Group Change Request		Cherokee Health Systems 255 E Watt St Alcoa, TN 37701	8/16/2021 9:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1033781588	8/16/2021 9:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/16/2021 9:50 AM
Addresses	Shipping Address	Insert	Recertification		Cherokee Health Systems 4330 Maynardville Hwy Maynardville, TN 37807-3618	2/16/2021 9:01 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3706725 (TN)		2/16/2021 9:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2021 9:01 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3386393	2/16/2021 9:01 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	2/16/2021 9:01 PM
Medicaid Billing	NPI: State	Update	Recertification		TN	2/16/2021 9:01 PM
Medicaid Billing	NPI: State	Update	Recertification		TN	2/16/2021 9:01 PM
Medicaid Billing	NPI: State	Update	Recertification		TN	2/16/2021 9:01 PM
Medicaid Billing	NPI: State	Update	Recertification		TN	2/16/2021 9:01 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 11:07:20 AM	2/16/2021 9:01:10 PM	2/16/2021 9:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/19/2020 11:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3706725	2/19/2020 11:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	2/19/2020 11:40 AM
Details	Last Recertification Date	Update	Recertification	1/31/2019 10:59:35 AM	1/30/2020 11:07:20 AM	1/30/2020 11:07 AM
Details	Last Recertification Date	Update	Recertification	3/1/2018 9:32:40 AM	1/31/2019 10:59:35 AM	1/31/2019 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/1/2018 8:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q036968	10/1/2018 8:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	10/1/2018 8:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/1/2018 8:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q036969	10/1/2018 8:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	10/1/2018 8:57 AM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	3/1/2018 9:32:40 AM	3/1/2018 9:32 AM
Contacts	Authorizing Official	Update	Profile Change Request	Howard, Jeff W CFO Cherokee Health Systems 8655440406	Howard, Jeffrey W CFO Cherokee Health Systems 8659346708	1/9/2018 1:46 PM
Contacts	Authorizing Official	Update		Howard, Jeff CFO 8655440406	Howard, Jeff W CFO Cherokee Health Systems 8655440406	1/9/2018 1:44 PM
Contacts	Primary Contact	Update		Clawson, Karen Pharmacy Director 8655440406	Clawson, Karen Pharmacy Director Cherokee Health Systems 8655440406-6727	9/22/2017 2:36 PM
Contacts	Authorizing Official	Update		Hornberger, Joel CSO 8655440406	Howard, Jeff CFO 8655440406	5/16/2017 11:09 AM
Contacts	Primary Contact	Insert			Clawson, Karen Pharmacy Director 8655440406	5/16/2017 11:09 AM
Addresses	Main Address	Insert			4330 Maynardville Hwy Maynardville, TN 37807-3618	2/2/2017 12:14 PM
Addresses	Shipping Address	Insert			Cherokee Health Systems 2018 Western Ave Knoxville, TN 37921	2/2/2017 12:14 PM
Addresses	Shipping Address	Insert			CHEROKEE HEALTH SYSTEMS 501 ADESA BLVD SUITE A-150 LENOIR CITY, TN 37771	2/2/2017 12:14 PM
Details	Last Recertification Date	Update		2/17/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 12:14 PM
Contacts	Authorizing Official	Insert			Hornberger, Joel CSO 8655440406	2/2/2017 12:14 PM
Addresses	Billing Address	Insert			CHEROKEE HEALTH SYSTEMS 6350 W. ANDREW JOHNSON HWY TALBOTT, TN 37877	8/25/2016 3:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/25/2016 3:19 PM
Medicaid Billing	Medicaid: Number	Insert			0441846	8/25/2016 3:19 PM
Medicaid Billing	Medicaid: State	Insert			TN	8/25/2016 3:19 PM
Medicaid Billing	NPI: Number	Insert			1487891594	8/25/2016 3:19 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/17/2016 12:00:00 AM	2/17/2016 11:36 AM
Details	Last Recertification Date	Update		3/22/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 8:35 AM
Medicaid Billing	NPI: Number	Insert			1841397783	3/22/2014 9:10 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/22/2014 12:00:00 AM	3/22/2014 9:10 PM
Details	Entity Subname	Update			CHEROKEE HLTH SYSTEMS - MAYNARDV	3/22/2014 9:10 PM
Medicaid Billing	NPI: Number	Insert			1134128820	3/4/2013 9:08 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 9:08 AM
Medicaid Billing	NPI: Number	Insert			1881763126	1/9/2013 1:33 PM
Details	Last Recertification Date	Insert				6/23/2006 3:39 PM
Details	Grant Number	Insert			H80CS00309	6/23/2006 3:39 PM
Details	340B ID	Insert			CH041309I	6/23/2006 3:39 PM
Details	Is Authorizing Official EHB Data	Insert				6/23/2006 3:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/23/2006 3:39 PM
Details	Medicare Provider Number	Insert				6/23/2006 3:39 PM
Details	Entity Name	Insert			CHEROKEE HEALTH SYSTEMS	6/23/2006 3:39 PM
Details	Program Code	Insert			CH	6/23/2006 3:39 PM
Details	Entity Subname	Insert				6/23/2006 3:39 PM
Dates	Participating Approval Date	Insert			5/16/2005 12:00:00 AM	6/23/2006 3:39 PM
Details	State	Insert			Active	6/23/2006 3:39 PM
Dates	Registration Date	Insert			7/1/2005 12:00:00 AM	6/23/2006 3:39 PM
Dates	Signed By Date	Insert			4/28/2005 12:00:00 AM	6/23/2006 3:39 PM
Dates	Start Date	Insert			7/1/2005 12:00:00 AM	6/23/2006 3:39 PM
Terminations	Termination Comments	Insert				6/23/2006 3:39 PM
Terminations	Termination Date	Insert				6/23/2006 3:39 PM
Terminations	Termination Effective Date	Insert				6/23/2006 3:39 PM
Terminations	Termination Reason	Insert				6/23/2006 3:39 PM
Details	Comments Public	Insert			NEW SITE 07/01/2005; 6/23/06 - ADDED SHIPPING ADDRESS	6/23/2006 3:39 PM

340B Drug Pricing Program Database