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NPS PHARMACY AT ETSU
RWII37604A East Tennessee State University Center of Excellence
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Covered Entity Details
Entity Name
East Tennessee State University Center of Excellence
Subdivision Name
Type
Ryan White Part B
340B ID
RWII37604A
Entity Address
105 W. Park Drive, Suite 200
Kingsport, TN 37660
Grant Number
X07HA00024
Participating Start Date
7/1/2024
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
NPS PHARMACY AT ETSU
Pharmacy Address
615 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604-8209
Pharmacy Comments
Contract Details
Approval Date
5/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Moorman, Director ETSU Center of Excellence
(423) 979-6380
Contract Pharmacy Representative
NPS
kevin hartman, owner
(615) 371-1210
Signed By Date
5/10/2024
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