Contract Pharmacy Details

VISE'S PHARMACY
CH041370 PERRY COUNTY MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

PERRY COUNTY MEDICAL CENTER, INC.

Subdivision Name

PERRY COUNTY MEDICAL CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH041370

Entity Address

115 E BROOKLYN STREET
LINDEN, TN 37096

Grant Number

H80CS00346

Participating Start Date

4/1/2005

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

VISE'S PHARMACY

Pharmacy Address

122 LOBELVILLE HWY
LINDEN, TN 37096

Pharmacy Comments

Contract Details

Approval Date

1/10/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/15/2024
Ownership change

Contacts

Covered Entity Signing Official

PHILLIP TATUM, CEO
(931) 589-2104

Contract Pharmacy Representative

Vise's Pharmacy
Ronnie Vise, Owner
(731) 847-3784

Signed By Date

1/10/2022