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ROAN MOUNTAIN PHARMACY
CH0412790 RURAL HEALTH SERVICES CONSORTIUM
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM
Subdivision Name
HAWKINS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH0412790
Entity Address
4966 HIGHWAY 11 WEST
ROGERSVILLE, TN 37857
Grant Number
H80CS00421
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ROAN MOUNTAIN PHARMACY
Pharmacy Address
8251 HIGHWAY 19 E
ROAN MOUNTAIN, TN 37687
Pharmacy Comments
Contract Details
Approval Date
8/12/2019
Contract Begin Date
8/12/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Roan Mountain Pharmacy
Jordon Baker, Pharmacist
(423) 772-3591
Signed By Date
8/12/2019
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