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WAL-MART PHARMACY 10-4635
STD379171 Positively Living
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Covered Entity Details
Entity Name
Positively Living
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD379171
Entity Address
1925 Ailor Ave
Knoxville, TN 37921
Grant Number
1NU65PS923764-01-00
Participating Start Date
4/1/2018
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4635
Pharmacy Address
150 TANNER LANE
CLINTON, TN 37716
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
5/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Jenkins, Chief Executive Officer
(865) 556-5217
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/25/2019
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