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K & B TENNESSEE CORPORATION
DSH440152 Regional One Health
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Covered Entity Details
Entity Name
Regional One Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440152
Entity Address
877 JEFFERSON AVENUE
MEMPHIS, TN 38103
Medicare Provider Number
440152
Participating Start Date
4/1/1993
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
K & B TENNESSEE CORPORATION
Pharmacy Address
RITE AID #7202
2670 FRAYSER BOULEVARD
MEMPHIS, TN 38127
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/20/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Rick Wagers, CFO
(901) 545-7676
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/8/2013
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