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MISSISSIPPI CVS PHARMACY, L.L.C.
RWII37917 Positively Living, Inc.
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Covered Entity Details
Entity Name
Positively Living, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII37917
Entity Address
1925 Ailor Ave
Knoxville, TN 37921
Grant Number
X07HA00024
Participating Start Date
4/1/2016
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08954
7363 GOODMAN RD.
OLIVE BRANCH, MS 38654
Pharmacy Comments
Contract Details
Approval Date
10/25/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2021
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
10/25/2019
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