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WALGREEN CO.
CH041370 PERRY COUNTY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PERRY COUNTY MEDICAL CENTER, INC.
Subdivision Name
PERRY COUNTY MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH041370
Entity Address
115 E BROOKLYN STREET
LINDEN, TN 37096
Grant Number
H80CS00346
Participating Start Date
4/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18040
650 HIGHWAY 100
CENTERVILLE, TN 37033-1214
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHILLIP TATUM, CEO
(931) 589-2104
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2019
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