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ANOVORX GROUP, LLC
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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Covered Entity Details
Entity Name
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440049
Entity Address
1265 Union Ave
Memphis, TN 38104
Medicare Provider Number
440049
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
ANOVORX GROUP, LLC
Pharmacy Address
1710 SHELBY OAKS DR N
STE 5
MEMPHIS, TN 38134-7403
Pharmacy Comments
Contract Details
Approval Date
1/4/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chuck Lane, SVP/Associate CFO
(901) 516-0549
Contract Pharmacy Representative
AnovoRx Group, LLC
Jon Peters, President
(901) 201-5484
Signed By Date
1/4/2019
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