Contract Pharmacy Details

CARTERS DRUG STORE
DSH440102 HH Health System - Lincoln, Inc.

Covered Entity Details

Entity Name

HH Health System - Lincoln, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440102

Entity Address

106 MEDICAL CENTER BLVD
FAYETTEVILLE, TN 37334

Medicare Provider Number

440102

Participating Start Date

10/1/2004

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

CARTERS DRUG STORE

Pharmacy Address

106 ELK AVE S
FAYETTEVILLE, TN 37334-3733

Pharmacy Comments

Contract Details

Approval Date

10/8/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/22/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robert Lonis, CFO
(931) 438-7471

Contract Pharmacy Representative

Carters Drug Store
Sharon Cunningham, Main POC
(931) 433-1511

Signed By Date

10/8/2018

340B Drug Pricing Program Database