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TENNESSEE CVS PHARMACY, L.L.C.
DSH440084 SWEETWATER HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
SWEETWATER HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440084
Entity Address
304 WRIGHT STREET
SWEETWATER, TN 37874
Medicare Provider Number
440084
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05668
4515 HWY 411
MADISONVILLE, TN 37354
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Reynolds, Chief Financial Officer
(865) 213-8582
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2022
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