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TENNESSEE CVS PHARMACY, L.L.C.
DSH440104 Erlanger Health
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Covered Entity Details
Entity Name
Erlanger Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440104
Entity Address
975 East Third Street
CHATTANOOGA, TN 37403
Medicare Provider Number
440104
Participating Start Date
12/1/1992
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05665
8034 E. BRAINERD RD.,
CHATTANOOGA, TN 37421
Pharmacy Comments
Contract Details
Approval Date
7/16/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
Andrea Waldrop, Pharmacist in Charge
(423) 894-3836
Signed By Date
7/16/2017
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