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HUDSON DRUG STORE INC
CH045190 HARDEMAN COUNTY COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Subdivision Name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH045190
Entity Address
629 Nuckolls Rd
Bolivar, TN 38008-1599
Grant Number
H80CS00530
Participating Start Date
7/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HUDSON DRUG STORE INC
Pharmacy Address
600 NUCKOLLS ROAD
BOLIVAR, TN 38008
Pharmacy Comments
Contract Details
Approval Date
3/15/2005
Contract Begin Date
3/15/2005
Carve-In Effective Date
Contract Comments
5/26/06 - NEW ADDRESS (WAS 105 NORTH MAIN STREET)
Contract Termination Date
Termination Reason
5/13/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/11/2005
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