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TENNESSEE CVS PHARMACY, L.L.C.
RRC010039-00 HUNTSVILLE HOSPITAL
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Covered Entity Details
Entity Name
HUNTSVILLE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010039-00
Entity Address
101 SIVLEY ROAD SW
HUNTSVILLE, AL 35801
Medicare Provider Number
010039
Participating Start Date
12/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04352
1107 HUNTSVILLE HIGHWAY
FAYETTEVILLE, TN 37334
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
1/18/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/24/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Clinton Carter, CFO
(256) 265-8818
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2022
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