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TENNESSEE CVS PHARMACY, L.L.C.
CH041370 PERRY COUNTY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PERRY COUNTY MEDICAL CENTER, INC.
Subdivision Name
PERRY COUNTY MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH041370
Entity Address
115 E BROOKLYN STREET
LINDEN, TN 37096
Grant Number
H80CS00346
Participating Start Date
4/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06393
122 HWY 70 EAST
DICKSON, TN 37055
Pharmacy Comments
Contract Details
Approval Date
7/5/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHILLIP TATUM, CEO
(931) 589-2104
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/5/2022
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