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WAL-MART PHARMACY 10-0724
CH04681A RURAL MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
RURAL MEDICAL SERVICES, INC.
Subdivision Name
PARROTTSVILLE CENTER
Type
HRSA-Funded Health Center
340B ID
CH04681A
Entity Address
111 Mockingbird Ave
Parrottsville, TN 37843-2741
Grant Number
H80CS00406
Participating Start Date
12/1/1992
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0724
Pharmacy Address
630 E BROADWAY
JEFFERSON CITY, TN 37760
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LARRY STANIFER, CEO
(423) 613-3300
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/10/2019
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