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TENNESSEE CVS PHARMACY, L.L.C.
CH04126A ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
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Covered Entity Details
Entity Name
ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
Subdivision Name
DODSON AVENUE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04126A
Entity Address
1200 DODSON AVE
CHATTANOOGA, TN 37406
Grant Number
H80CS00091
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03734
5011-A STATE STREET
CHATTANOOGA, TN 37407
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2020
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