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ASCENSION PHARMACY SERVICES, LLC
CAH441300-00 HICKMAN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HICKMAN COMMUNITY HOSPITAL
Subdivision Name
DBA SAINT THOMAS HICKMAN HOSPITAL
Type
Critical Access Hospital
340B ID
CAH441300-00
Entity Address
135 EAST SWAN STREET
CENTERVILLE, TN 37033
Medicare Provider Number
441300
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ASCENSION PHARMACY SERVICES, LLC
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
1/19/2022
Contract Begin Date
1/26/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Davis, Saint Thomas Health/Nashville/CEO
(615) 284-6845
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Suzanne Noe, Pharmacist
(248) 865-3770
Signed By Date
1/19/2022
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