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WALGREEN CO.
DSH440007 UNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
UNITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440007
Entity Address
481 INTERSTATE DRIVE
MANCHESTER, TN 37355
Medicare Provider Number
440007
Participating Start Date
10/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06340
700 N JACKSON ST
TULLAHOMA, TN 37388
Pharmacy Comments
Contract Details
Approval Date
7/26/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Martha Henley, Chief Executive Officer
(931) 450-1701
Contract Pharmacy Representative
Walgreens
Kenitra Washington, Pharmacy Manager
(931) 455-6777
Signed By Date
7/10/2019
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