Covered Entity Details

CH04656G Hardin County Regional Health Center (Terminated) - information as of 6/27/2025 12:34:13 AM

Main Details

Name

Hardin County Regional Health Center

Subdivision Name

Lifespan Saltillo

Type

HRSA-Funded Health Center

Site ID

BPS-H80-010634

340B ID

CH04656G

Grant Number

H80CS00180

Additional Details

Current Program Status

Terminated

Registration Date

1/26/2012

Participating Start Date

4/1/2012

Participating Approval Date

3/2/2012

Last Recertification Date

2/13/2018

Termination Date
Termination Reason

7/1/2018
Site closure

Contacts

Authorizing Official

Hardin County Regional Health Center dba Lifespan Health
Y. T. McGinley, CEO
(731) 925-2300 Ext: 8968

Primary Contact

Hardin County Regional Health Center
Jennifer Williams, CFO
(731) 925-2300

Addresses

Street Address

48073 Highway 69
Saltillo, TN 38370-4514

Billing Address

Hardin County Regional Health Center
PO Box 655
Savannah, TN 38372-0655

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

Comments

Comment	Last Updated On
No records to display.

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	0441944,3707027
		1184676157,1962790238

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH046560	Active	BPS-H80-005553	HARDIN COUNTY REGIONAL HEALTH CENTER	DBA LIfespan Health	765 FLORENCE ROAD	SAVANNAH	TN
CH04656C	Active	BPS-H80-003582	HARDIN COUNTY REGIONAL HEALTH CENTER	Lifespan Health	150 EAST END DRIVE	SAVANNAH	TN
CH04656D	Active	BPS-H80-002685	HARDIN COUNTY REGIONAL HEALTH CENTER	Lifespan Clifton	207 MAIN STREET	CLIFTON	TN
CH04656E	Terminated	BPS-H80-008091	HARDIN COUNTY REGIONAL HEALTH CENTER	LIFESPAN HEALTH	720 HWY 99	WAYNESBORO	TN
CH04656F	Terminated	BPS-H80-008170	HARDIN COUNTY REGIONAL HEALTH CENTER	LIFESPAN HEALTH	105 DAVIS STREET	SAVANNAH	TN
CH04656G	Terminated	BPS-H80-010634	Hardin County Regional Health Center	Lifespan Saltillo	48073 Highway 69	Saltillo	TN
CH04656H	Active	BPS-H80-017096	HARDIN COUNTY REGIONAL HEALTH CENTER	LIfespan Adamsville	726 E Main Street	Adamsville	TN
CH04656J	Terminated	BPS-H80-017762	HARDIN COUNTY REGIONAL HEALTH CENTER	Lifespan Health - SMC	255 Wayne Road	Savannah	TN
CH04656K	Active	BPS-H80-028147	Hardin County Regional Health Center	Lifespan Selmer	181 S Y Square	Selmer	TN
CH04656L	Active	BPS-H80-032410	Hardin County Regional Health Center	Lifespan Enoch Blvd	175 Enoch Blvd	Savannah	TN
CH04656M	Active	BPS-H80-035485	Hardin County Regional Health Center	Lifespan Health Admin	880 Pickwick St UNIT 2	Savannah	TN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH046560	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2015	10/04/2023
CH046560	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2018	12/28/2020
CH046560	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	01/19/2021
CH046560	BOB'S DISCOUNT PHARMACY	555 PICKWICK ST		SAVANNAH	TN	38372-3082	04/20/2012	10/01/2016
CH046560	BOB'S DISCOUNT PHARMACY	555 PICKWICK ST		SAVANNAH	TN	38372-3082	10/01/2019
CH04656C	BOB'S DISCOUNT PHARMACY	555 PICKWICK ST		SAVANNAH	TN	38372-3082	04/01/2023
CH046560	CARROLL PHARMACY	835 PICKWICK ST		SAVANNAH	TN	38372	04/01/2016
CH04656D	CARROLL PHARMACY	835 PICKWICK ST		SAVANNAH	TN	38372	04/01/2023
CH046560	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2022
CH046560	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2022
CH046560	DEBERRY DRUGS	834 MULBERRY AVE		SELMER	TN	38375	10/01/2019
CH046560	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/01/2017	02/14/2020
CH046560	DUREN CLINICAL SERVICES LLC	DBA DUREN PHARMACY	215 DEXTER L WOODS MEMORIAL BLVD PO BOX 736	WAYNESBORO	TN	38485	07/16/2010
CH04656C	DUREN CLINICAL SERVICES LLC	DBA DUREN PHARMACY	215 DEXTER L WOODS MEMORIAL BLVD PO BOX 736	WAYNESBORO	TN	38485	07/16/2010
CH04656D	DUREN CLINICAL SERVICES LLC	DBA DUREN PHARMACY	215 DEXTER L WOODS MEMORIAL BLVD PO BOX 736	WAYNESBORO	TN	38485	07/16/2010
CH04656E	DUREN CLINICAL SERVICES LLC	DBA DUREN PHARMACY	215 DEXTER L WOODS MEMORIAL BLVD PO BOX 736	WAYNESBORO	TN	38485	07/16/2010	10/01/2016
CH04656F	DUREN CLINICAL SERVICES LLC	DBA DUREN PHARMACY	215 DEXTER L WOODS MEMORIAL BLVD PO BOX 736	WAYNESBORO	TN	38485	07/16/2010	01/01/2022
CH046560	H & M APOTHECARY, LLC	D/B/A EAST MAIN PHARMACY	712 EAST MAIN STREET P.O. BOX 314	ADAMSVILLE	TN	38310-3831	10/01/2014	12/31/2018
CH046560	KROGER PHARMACY	775 PICKWICK ROAD		SAVANNAH	TN	38372	04/01/2019
CH046560	MAIN STREET PHARMACY	APOTHECARY CONSULTANTS, LLC	110 MAIN ST	SAVANNAH	TN	38372-2412	07/16/2010
CH04656C	MAIN STREET PHARMACY	APOTHECARY CONSULTANTS, LLC	110 MAIN ST	SAVANNAH	TN	38372-2412	07/16/2010
CH04656D	MAIN STREET PHARMACY	APOTHECARY CONSULTANTS, LLC	110 MAIN ST	SAVANNAH	TN	38372-2412	07/16/2010
CH04656F	MAIN STREET PHARMACY	APOTHECARY CONSULTANTS, LLC	110 MAIN ST	SAVANNAH	TN	38372-2412	07/16/2010	01/01/2022
CH04656H	MAIN STREET PHARMACY	APOTHECARY CONSULTANTS, LLC	110 MAIN ST	SAVANNAH	TN	38372-2412	04/01/2023
CH046560	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2019	01/19/2021
CH046560	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10072	855 WAYNE RD.	SAVANNAH	TN	38372	01/01/2022
CH04656M	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10072	855 WAYNE RD.	SAVANNAH	TN	38372	04/01/2023
CH046560	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	04/01/2007
CH04656C	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	02/22/2007
CH04656D	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	07/16/2010
CH04656E	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	07/16/2010	10/01/2016
CH04656F	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	07/16/2010	01/01/2022
CH04656K	THE PRESCRIPTION SHOP	765 FLORENCE RD	STE B	SAVANNAH	TN	38372-5219	04/01/2023
CH046560	TODD'S DISCOUNT DRUGS	347 E MAIN ST	PO BOX 576	ADAMSVILLE	TN	38310-2321	04/06/2012
CH04656H	TODD'S DISCOUNT DRUGS	347 E MAIN ST	PO BOX 576	ADAMSVILLE	TN	38310-2321	04/01/2023
CH04656L	TODD'S DISCOUNT DRUGS	347 E MAIN ST	PO BOX 576	ADAMSVILLE	TN	38310-2321	04/01/2023
CH046560	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	09/24/2020	10/01/2023
CH046560	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2019
CH046560	WAL-MART PHARMACY 10-0218	1017 MULBERRY AVENUE		SELMER	TN	38375	10/01/2019
CH046560	WAL-MART PHARMACY 10-0268	175 J.I. BELL LANE		SAVANNAH	TN	38372	09/21/2012	02/16/2018
CH046560	WAL-MART PHARMACY 10-0268	175 J.I. BELL LANE		SAVANNAH	TN	38372	10/01/2019
CH046560	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2019
CH046560	WALGREEN CO.	DBA: WALGREENS # 01913	2026 HWY 72 E	CORINTH	MS	38834-6709	10/01/2013
CH046560	WALGREEN CO.	DBA: WALGREENS # 03953	106 W NORTHFIELD	MURFREESBORO	TN	37129	10/01/2013
CH046560	WALGREEN CO.	DBA: WALGREENS # 06277	2401 OLD FORT PARKWAY	MURFREESBORO	TN	37128	10/01/2013
CH046560	WALGREEN CO.	DBA: WALGREENS # 06693	3389 MEMORIAL BLVD	MURFREESBORO	TN	37129-5257	10/01/2013
CH046560	WALGREEN CO.	DBA: WALGREENS #10871	800 WAYNE RD.	SAVANNAH	TN	38372-1968	10/01/2013
CH046560	WALGREEN CO.	WALGREENS #17551	409 MULBERRY AVE	SELMER	TN	38375-2307	10/01/2019
CH046560	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH046560	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/09/2015
CH046560	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH046560	WILLOUGHBY DRUGS	WILLOUGHBY	104 MAIN ST P.O. BOX 194	CLIFTON	TN	38425	04/01/2016	06/30/2016
CH046560	WILLOUGHBY DRUGS	104 MAIN ST		CLIFTON	TN	38425	01/01/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	New Registration	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300-8968	7/8/2021 11:10 AM
Contacts	Signed By	Update	New Registration	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300-8968	7/8/2021 11:10 AM
Details	State	Update		To Be Terminated	Terminated	7/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/30/2018 12:00:00 AM	6/1/2018 2:44 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/1/2018 2:44 PM
Terminations	Termination Date	Update	Termination Request		7/1/2018 12:00:00 AM	6/1/2018 2:44 PM
Terminations	Termination Effective Date	Update	Termination Request		5/1/2018 12:00:00 AM	6/1/2018 2:44 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	6/1/2018 2:44 PM
Contacts	Primary Contact	Update	Recertification	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	Williams, Jennifer CFO Hardin County Regional Health Center 7319252300	2/13/2018 3:39 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/13/2018 3:39:54 PM	2/13/2018 3:39 PM
Contacts	Authorizing Official	Update		McGinley, Y. T. CEO 7319252300	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	10/10/2017 2:49 PM
Contacts	Primary Contact	Update		McGinley, Y. T. CEO 7319252300	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	10/10/2017 2:49 PM
Contacts	Signed By	Update		McGinley, Y. T. CEO 7319252300	McGinley, Y. T. CEO Hardin County Regional Health Center dba Lifespan Health 7319252300	10/10/2017 2:49 PM
Contacts	Authorizing Official	Insert			McGinley, Y. T. CEO 7319252300	3/24/2017 2:19 PM
Contacts	Primary Contact	Insert			McGinley, Y. T. CEO 7319252300	3/24/2017 2:19 PM
Contacts	Signed By	Insert			McGinley, Y. T. CEO 7319252300	3/24/2017 2:19 PM
Addresses	Main Address	Insert			48073 Highway 69 Saltillo, TN 38370-4514	1/25/2017 2:59 PM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 2:59 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 12:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/11/2015 9:18 AM
Medicaid Billing	Medicaid: Number	Insert			0441944	2/11/2015 9:18 AM
Medicaid Billing	Medicaid: State	Insert			TN	2/11/2015 9:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/11/2015 9:18 AM
Medicaid Billing	Medicaid: Number	Insert			3707027	2/11/2015 9:18 AM
Medicaid Billing	Medicaid: State	Insert			TN	2/11/2015 9:18 AM
Medicaid Billing	NPI: Number	Insert			1184676157	2/11/2015 9:18 AM
Medicaid Billing	NPI: Number	Insert			1962790238	2/11/2015 9:18 AM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 9:18 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/13/2014 12:00:00 AM	3/13/2014 10:27 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/20/2013 12:44 PM
Addresses	Billing Address	Insert			Hardin County Regional Health Center PO Box 655 Savannah, TN 38372-0655	3/2/2012 5:57 PM
Details	340B ID	Update		IS-FF-CH04656G	CH04656G	3/2/2012 5:57 PM
Dates	Participating Approval Date	Update			3/2/2012 12:00:00 AM	3/2/2012 5:57 PM
Details	State	Update		Pending	Active	3/2/2012 5:57 PM
Dates	Start Date	Update			4/1/2012 12:00:00 AM	3/2/2012 5:57 PM
Details	340B ID	Update		ONLINE_REG	IS-FF-CH04656G	1/31/2012 10:38 AM
Details	Entity Subname	Update		Lifespan Health	Lifespan Saltillo	1/31/2012 10:38 AM
Details	Last Recertification Date	Insert				1/26/2012 3:28 PM
Details	Grant Number	Insert			H80CS00180	1/26/2012 3:28 PM
Details	340B ID	Insert			ONLINE_REG	1/26/2012 3:28 PM
Details	Is Authorizing Official EHB Data	Insert				1/26/2012 3:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/26/2012 3:28 PM
Details	Medicare Provider Number	Insert				1/26/2012 3:28 PM
Details	Entity Name	Insert			Hardin County Regional Health Center	1/26/2012 3:28 PM
Details	Program Code	Insert			CH	1/26/2012 3:28 PM
Details	Entity Subname	Insert			Lifespan Health	1/26/2012 3:28 PM
Dates	Participating Approval Date	Insert				1/26/2012 3:28 PM
Details	State	Insert			Pending	1/26/2012 3:28 PM
Dates	Registration Date	Insert			1/26/2012 12:00:00 AM	1/26/2012 3:28 PM
Dates	Signed By Date	Insert			1/26/2012 12:00:00 AM	1/26/2012 3:28 PM
Dates	Start Date	Insert				1/26/2012 3:28 PM
Terminations	Termination Comments	Insert				1/26/2012 3:28 PM
Terminations	Termination Date	Insert				1/26/2012 3:28 PM
Terminations	Termination Effective Date	Insert				1/26/2012 3:28 PM
Terminations	Termination Reason	Insert				1/26/2012 3:28 PM

340B Drug Pricing Program Database