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PUBLIX TENNESSEE, LLC
RRC440059-00 COOKEVILLE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COOKEVILLE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440059-00
Entity Address
142 WEST FIFTH STREET
COOKEVILLE, TN 38501
Medicare Provider Number
440059
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
PUBLIX TENNESSEE, LLC
Pharmacy Address
PUBLIX PHARMACY #1634
1265 INTERSTATE DR STE 111
COOKEVILLE, TN 38501-5197
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAUL Dudley KORTH, CEO
(931) 783-2000
Contract Pharmacy Representative
Publix Super Markets
Dain Rusk, Vice President Pharmacy
(863) 616-5846
Signed By Date
1/14/2019
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