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ASCENSION RX 1206
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 RX 1206
Pharmacy Address
150 E SWAN ST
CENTERVILLE, TN 37033
Pharmacy Comments
Contract Details
Approval Date
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Davis, Saint Thomas Health/Nashville/CEO
(615) 284-6845
Contract Pharmacy Representative
Hickman Charitable Pharmacy
Cassie Coleman, Pharmacist
(931) 729-6798
Signed By Date
4/7/2022
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