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MOONEY'S PHARMACY INC
CH041349C EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
Johnson City Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH041349C
Entity Address
2151 Century Lane
Johnson City, TN 37604
Grant Number
H80CS00840
Participating Start Date
9/9/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MOONEY'S PHARMACY INC
Pharmacy Address
CENTRAL SHOPPING CENTER
1107 NORTH ROAN ST
JOHNSON CITY, TN 37604
Pharmacy Comments
Contract Details
Approval Date
7/13/2006
Contract Begin Date
7/13/2006
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/19/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/1/2006
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