Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
RWII37917 Positively Living, Inc.

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

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08954
7363 GOODMAN RD.
OLIVE BRANCH, MS 38654

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/30/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Steve Jenkins, Chief Executive Officer
(865) 556-5217

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/15/2021

340B Drug Pricing Program Database