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WAL-MART PHARMACY 10-0366
CH0442510 CHOTA COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
CHOTA COMMUNITY HEALTH SERVICES
Subdivision Name
CHOTA COMMUNITY HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH0442510
Entity Address
1206 US Highway 411
VONORE, TN 37885
Grant Number
H80CS06461
Participating Start Date
10/20/2005
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0366
Pharmacy Address
4525 HWY 411
MADISONVILLE, TN 37354
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Harris, CEO
(423) 442-7268
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/13/2014
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