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TENNESSEE CVS PHARMACY, L.L.C.
CH044790 PRIMARY HEALTH CARE CENTER OF DADE, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Subdivision Name
PRIMARY HEALTH CARE CENTER TRENTON
Type
HRSA-Funded Health Center
340B ID
CH044790
Entity Address
13570 N Main St
Trenton, GA 30752-2012
Grant Number
H80CS00649
Participating Start Date
1/1/1998
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03734
5011-A STATE STREET
CHATTANOOGA, TN 37407
Pharmacy Comments
Contract Details
Approval Date
1/7/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/10/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2022
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