Contract Pharmacy Details

KROGER PHARMACY #531
DSH440015 UNIVERSITY OF TENNESSEE MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF TENNESSEE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440015

Entity Address

1924 ALCOA HWY
KNOXVILLE, TN 37920

Medicare Provider Number

440015

Participating Start Date

7/1/2001

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #531

Pharmacy Address

4409 CHAPMAN HWY
KNOXVILLE, TN 37920

Pharmacy Comments

Contract Details

Approval Date

4/5/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

TOM FISHER, CFO
(865) 305-6097

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

4/5/2013

340B Drug Pricing Program Database