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HUDSON DRUG STORE #3579
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 #3579
Pharmacy Address
600 NUCKOLLS RD.
BOLIVAR, TN 38008-1532
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/15/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARY HEINZEN, CEO
(731) 659-3114
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
10/17/2016
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