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WAL-MART PHARMACY 10-0094
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
WAL-MART PHARMACY 10-0094
Pharmacy Address
8445 HWY 51 NORTH
MILLINGTON, TN 38053
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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