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RITE AID OF TENNESSEE, INC.
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
RITE AID OF TENNESSEE, INC.
Pharmacy Address
RITE AID #1297
103 NORTH SHADY STREET
MOUNTAIN CITY, TN 37683
Pharmacy Comments
Contract Details
Approval Date
9/7/2012
Contract Begin Date
9/7/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Rite Aid
Ruth Lightner, Director
(717) 731-6524
Signed By Date
8/20/2012
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