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WAL-MART PHARMACY 10-5997
CH0413490 EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
EAST TENNESSEE STATE UNIVERSITY COLLEGE OF NURSING
Type
HRSA-Funded Health Center
340B ID
CH0413490
Entity Address
400 JL Seehorn Road
JOHNSON CITY, TN 37614
Grant Number
H80CS00840
Participating Start Date
7/1/1995
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Silas Tolan, Executive Director
(423) 439-4051
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/10/2020
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