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ROAN MOUNTAIN PHARMACY
CH0412790 RURAL HEALTH SERVICES CONSORTIUM
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM
Subdivision Name
HAWKINS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH0412790
Entity Address
4966 HIGHWAY 11 WEST
ROGERSVILLE, TN 37857
Grant Number
H80CS00421
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ROAN MOUNTAIN PHARMACY
Pharmacy Address
8251 HWY 19E
ROAN MOUNTAIN, TN 37687-3343
Pharmacy Comments
Contract Details
Approval Date
4/12/2011
Contract Begin Date
4/12/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/12/2019
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
4/12/2011
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