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WAL-MART PHARMACY 10-1080
CH041349C EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
Johnson City Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH041349C
Entity Address
2151 Century Lane
Johnson City, TN 37604
Grant Number
H80CS00840
Participating Start Date
9/9/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1080
Pharmacy Address
3111 BROWNS MILL ROAD
JOHNSON CITY, TN 37604
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa Queen, Business Director
(423) 439-4076
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/12/2024
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