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WALMART PHARMACY 10-4671
RWII37404 Positively Living, Inc.
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Covered Entity Details
Entity Name
Positively Living, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII37404
Entity Address
5721 Marlin Rd
3600
Chattanooga, TN 37411
Grant Number
X07HA00024
Participating Start Date
7/1/2018
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4671
Pharmacy Address
4110 SHALLOWFORD RD
CHATTANOOGA, TN 37411
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Steve Jenkins, Chief Executive Officer
(865) 556-5217
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/14/2019
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