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JELLICO DRUG STORE INC
CH04216F DAYSPRING HEALTH, INC.
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Covered Entity Details
Entity Name
DAYSPRING HEALTH, INC.
Subdivision Name
Dayspring Williamsburg Independent School
Type
HRSA-Funded Health Center
340B ID
CH04216F
Entity Address
1000 Main St
Williamsburg, KY 40769-1000
Grant Number
H80CS00716
Participating Start Date
4/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
JELLICO DRUG STORE INC
Pharmacy Address
JELLICO DRUG INC
229 S MAIN ST
JELLICO, TN 37762-2018
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lawrence Michael Rector, CEO
(423) 784-8492 Ext: 221
Contract Pharmacy Representative
Capture Rx
Sue Hill, ECRM
(210) 587-3486 Ext: 104
Signed By Date
7/9/2024
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