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MOUNTAIN CITY PHARMACY
CH041279K RURAL HEALTH SERVICES CONSORTIUM
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM
Subdivision Name
LIMESTONE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH041279K
Entity Address
105 LIMESTONE RURITAN RD.
LIMESTONE, TN 37681
Grant Number
H80CS00421
Participating Start Date
4/1/1999
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN CITY PHARMACY
Pharmacy Address
1641 S SHADY ST
MOUNTAIN CITY, TN 37683
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
Boone Drug
Spencer Hodges, Vice President
(423) 727-0038
Signed By Date
5/3/2023
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