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WAL-MART PHARMACY 10-0619
CAH441306-00 Erlanger Health dba Erlanger Bledsoe Hospital
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Covered Entity Details
Entity Name
Erlanger Health dba Erlanger Bledsoe Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH441306-00
Entity Address
71 Wheelertown Avenue
Pikeville, TN 37367
Medicare Provider Number
441306
Participating Start Date
7/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0619
Pharmacy Address
3034 RHEA COUNTY HWY
DAYTON, TN 37321
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/9/2020
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