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TENNESSEE CVS PHARMACY, L.L.C.
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
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Covered Entity Details
Entity Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440039
Entity Address
1211 MEDICAL CENTER DRIVE
NASHVILLE, TN 37232
Medicare Provider Number
440039
Participating Start Date
7/1/2002
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07280
1100 WEST ELK AVE.
ELIZABETHTON, TN 37643
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
James Edgar Newman, Vice President
(615) 293-3406
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2023
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