Contract Pharmacy Details

CVS TN DISTRIBUTION, LLC
DSH340002 MISSION HOSPITALS, INC.

Covered Entity Details

Entity Name

MISSION HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340002

Entity Address

509 BILTMORE AVENUE
ASHEVILLE, NC 28801

Medicare Provider Number

340002

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

CVS TN DISTRIBUTION, LLC

Pharmacy Address

10017 KINGSTON PIKE
KNOXVILLE, TN 37922

Pharmacy Comments

Contract Details

Approval Date

10/15/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/1/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul L McDowell, CFO
(828) 213-0184

Contract Pharmacy Representative

CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241

Signed By Date

10/15/2014

340B Drug Pricing Program Database