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TENNESSEE CVS PHARMACY, L.L.C.
CH041279I RURAL HEALTH SERVICES CONSORTIUM, INC.
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM, INC.
Subdivision Name
DRY CREEK MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH041279I
Entity Address
1826 N Main Ave
Erwin, TN 37650-8932
Grant Number
H80CS00421
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03792
420 PARK BLVD., #5
ROGERSVILLE, TN 37857
Pharmacy Comments
Contract Details
Approval Date
5/3/2023
Contract Begin Date
5/4/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
5/3/2023
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