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DRUG STORE
CH04123I OCOEE REGIONAL HEALTH CORPORATION
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Covered Entity Details
Entity Name
OCOEE REGIONAL HEALTH CORPORATION
Subdivision Name
BENTON FAMILY HEALTH CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH04123I
Entity Address
6784 HWY 411
BENTON, TN 37307-4818
Grant Number
H80CS00762
Participating Start Date
7/1/2015
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
DRUG STORE
Pharmacy Address
THE DRUG STORE
JERRY DON LOWERY
119 MAIN STREET
BENTON, TN 37307
Pharmacy Comments
Contract Details
Approval Date
6/1/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BILL MOATS, CEO
(423) 338-8995 Ext: 1212
Contract Pharmacy Representative
Jerry Lowery, Owner
(423) 338-2521
Signed By Date
6/1/2015
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