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TENNESSEE CVS PHARMACY, L.L.C.
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
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16204
9235 POPLAR AVE
GERMANTOWN, TN 38138
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2019
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