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ERLANGER PHARMACIES
DSH440104A ERLANGER MEDICAL CENTER
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Covered Entity Details
Entity Name
ERLANGER MEDICAL CENTER
Subdivision Name
ERLANGER EAST
Type
Disproportionate Share Hospital
340B ID
DSH440104A
Entity Address
1751 GUNBARREL ROAD
CHATTANOOGA, TN 37421
Medicare Provider Number
440104
Outpatient Facility Provider Number
Participating Start Date
1/1/2007
Last Recertification Date
9/2/2015
Entity Termination Date
10/1/2015
Pharmacy Details
Pharmacy Name
ERLANGER PHARMACIES
Pharmacy Address
DBA ERLANGER PHARMACY
979 EAST THIRD ST. SUITE 120
CHATTANOOGA, TN 37403
Pharmacy Comments
Contract Details
Approval Date
2/22/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
Donna Bourdon, President
(423) 386-1017
Signed By Date
1/18/2013
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