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WAL-MART PHARMACY 10-0667
CHC24149-00 MERCY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
MERCY HEALTH SERVICES, INC.
Subdivision Name
Mercy Health Services
Type
HRSA-Funded Health Center
340B ID
CHC24149-00
Entity Address
143 SE Parkway Ct
Franklin, TN 37064
Grant Number
H80CS24149
Participating Start Date
1/1/2013
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0667
Pharmacy Address
2111 N JACKSON ST
TULLAHOMA, TN 37388
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cindy J. Siler, CEO
(615) 790-0567 Ext: 200
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2021
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