Contract Pharmacy Details

TENNESSEE CVS PHARMACY, L.L.C.
RWII37404 Positively Living, Inc.

Covered Entity Details

Entity Name

Positively Living, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII37404

Entity Address

5721 Marlin Rd
3600
Chattanooga, TN 37411

Grant Number

X07HA00024

Participating Start Date

7/1/2018

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

TENNESSEE CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03721
4864 BROADWAY ST
KNOXVILLE, TN 37918

Pharmacy Comments

Contract Details

Approval Date

7/22/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/4/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Steve Jenkins, Chief Executive Officer
(865) 556-5217

Contract Pharmacy Representative

CVS
Rose Blake, Senior Director, Specialty Product Development
(901) 385-4100

Signed By Date

7/22/2019

340B Drug Pricing Program Database