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TENNESSEE CVS PHARMACY, L.L.C.
CAH441309-00 MARSHALL MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHALL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH441309-00
Entity Address
1080 NORTH ELLINGTON PKWY
LEWISBURG, TN 37091
Medicare Provider Number
441309
Participating Start Date
9/21/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 386
4805 COLUMBIA PIKE
THOMPSON STATION, TN 37179
Pharmacy Comments
Contract Details
Approval Date
1/19/2023
Contract Begin Date
1/27/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHYLLIS BROWN, CHIEF EXECUTIVE OFFICER
(931) 359-6241 Ext: 3306
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/19/2023
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