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TENNESSEE CVS PHARMACY, L.L.C.
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
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Covered Entity Details
Entity Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440039
Entity Address
1211 MEDICAL CENTER DRIVE
NASHVILLE, TN 37232
Medicare Provider Number
440039
Participating Start Date
7/1/2002
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 2386
1405 N. HIGHLAND AVENUE
JACKSON, TN 38301
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cecelia B Moore, Associate Vice Chancellor
(615) 322-0084
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2019
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