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BISE PLLC
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
BISE PLLC
Pharmacy Address
D/B/A SURGOINSVILLE PHARMACY
114 BELLAMY AVE
SURGOINSVILLE, TN 37873-2700
Pharmacy Comments
Contract Details
Approval Date
10/3/2014
Contract Begin Date
11/14/2014
Carve-In Effective Date
Contract Comments
11/14/2014 Immediate Contract Begin Date authorized
Contract Termination Date
Termination Reason
5/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Beth Bryan, Owner
(423) 345-0333
Signed By Date
10/3/2014
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