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WAL-MART PHARMACY 10-0684
CH041370 PERRY COUNTY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PERRY COUNTY MEDICAL CENTER, INC.
Subdivision Name
PERRY COUNTY MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH041370
Entity Address
115 E BROOKLYN STREET
LINDEN, TN 37096
Grant Number
H80CS00346
Participating Start Date
4/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0684
Pharmacy Address
547 WEST CHURCH STREET
LEXINGTON, TN 38351
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PHILLIP TATUM, CEO
(931) 589-2104
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/3/2019
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