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ASCENSION RX 1001
CAH441300-00 HICKMAN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HICKMAN COMMUNITY HOSPITAL
Subdivision Name
DBA SAINT THOMAS HICKMAN HOSPITAL
Type
Critical Access Hospital
340B ID
CAH441300-00
Entity Address
135 EAST SWAN STREET
CENTERVILLE, TN 37033
Medicare Provider Number
441300
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Davis, Saint Thomas Health/Nashville/CEO
(615) 284-6845
Contract Pharmacy Representative
ASCENSION RX 1001
ERICA WRIGHT, PHARMACY MANAGER
(833) 633-7279
Signed By Date
7/14/2021
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