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RITE AID OF TENNESSEE, INC.
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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Covered Entity Details
Entity Name
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440049
Entity Address
1265 Union Ave
Memphis, TN 38104
Medicare Provider Number
440049
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
RITE AID OF TENNESSEE, INC.
Pharmacy Address
RITE AID #7401
4642 QUINCE ROAD
MEMPHIS, TN 38117
Pharmacy Comments
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/20/2017
Ownership change
Contacts
Covered Entity Signing Official
CHRIS MCLEAN, SENIOR VP/CFO
(901) 516-0753
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/13/2015
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