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VONORE DRUG FAMILY WELLNESS CENTER, INC.
DSH440084 SWEETWATER HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
SWEETWATER HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440084
Entity Address
304 WRIGHT STREET
SWEETWATER, TN 37874
Medicare Provider Number
440084
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
VONORE DRUG FAMILY WELLNESS CENTER, INC.
Pharmacy Address
1121 HIGHWAY 411
VONORE, TN 37885
Pharmacy Comments
Contract Details
Approval Date
8/5/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ian McFadden, CEO
(865) 213-8525
Contract Pharmacy Representative
Vonore Drugs
Kristi Miller, Owner
(423) 884-6274
Signed By Date
8/4/2021
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