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MARCROM'S PHARMACY
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
MARCROM'S PHARMACY
Pharmacy Address
1277 MCARTHUR ST
MANCHESTER, TN 37355-2423
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
Marcrom Pharmacy
Tom Marcrom, Pharmacy Manager
(931) 728-1414
Signed By Date
7/15/2019
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