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EXPRESS RX OF RIPLEY
CHC00333-00 CITIZENS OF LAKE COUNTY FOR HEALTH CARE
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Covered Entity Details
Entity Name
CITIZENS OF LAKE COUNTY FOR HEALTH CARE
Subdivision Name
Lake County Primary Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC00333-00
Entity Address
710 Carl Perkins Parkway
TIPTONVILLE, TN 38079
Grant Number
H80CS00333
Participating Start Date
10/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EXPRESS RX OF RIPLEY
Pharmacy Address
SCPG TENNESSEE LLC
251 S WASHINGTON ST
RIPLEY, TN 38063
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GAYANNE WILLIAMS, EXECUTIVE DIRECTOR
(731) 253-6690
Contract Pharmacy Representative
Express RX
Galen Perkins, CEO
(501) 534-4400
Signed By Date
10/4/2022
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