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WINDHAM DRUG JELLICO, INC
CH042160 DAYSPRING HEALTH, INC.
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Covered Entity Details
Entity Name
DAYSPRING HEALTH, INC.
Subdivision Name
DAYSPRING HEALTH, INC.
Type
HRSA-Funded Health Center
340B ID
CH042160
Entity Address
107 S Main St
Jellico, TN 37762-2154
Grant Number
H80CS00716
Participating Start Date
10/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WINDHAM DRUG JELLICO, INC
Pharmacy Address
1184 5TH ST
JELLICO, TN 37762
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lawrence Michael Rector, COO/CFO
(423) 784-8492 Ext: 221
Contract Pharmacy Representative
Windham
Justin Smith, Owner
(606) 549-3636
Signed By Date
7/8/2020
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