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WALGREEN CO.
CH0413490 EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
EAST TENNESSEE STATE UNIVERSITY COLLEGE OF NURSING
Type
HRSA-Funded Health Center
340B ID
CH0413490
Entity Address
400 JL Seehorn Road
JOHNSON CITY, TN 37614
Grant Number
H80CS00840
Participating Start Date
7/1/1995
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11113
5104 BOBBY HICKS HWY.
GRAY, TN 37615-6217
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Silas Tolan, Executive Director
(423) 439-4051
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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