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JJ BEANS AT MOONEYS, LLC
CH0413490 EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
EAST TENNESSEE STATE UNIVERSITY COLLEGE OF NURSING
Type
HRSA-Funded Health Center
340B ID
CH0413490
Entity Address
400 JL Seehorn Road
JOHNSON CITY, TN 37614
Grant Number
H80CS00840
Participating Start Date
7/1/1995
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
JJ BEANS AT MOONEYS, LLC
Pharmacy Address
DBA MOONEYS PHARMACY
1107 N ROAN ST
JOHNSON CITY, TN 37601-3901
Pharmacy Comments
Contract Details
Approval Date
1/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Silas Tolan, Executive Director
(423) 439-4051
Contract Pharmacy Representative
JJ Beans at Mooneys, LLC
Chad Huntsman, Pharmacist
(423) 926-7333
Signed By Date
1/15/2022
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