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TENNESSEE CVS PHARMACY, L.L.C.
DSH440015 UNIVERSITY OF TENNESSEE MEDICAL CENTER
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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
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06361
718 WINFIELD DUNN PKWY.
SEVIERVILLE, TN 37876
Pharmacy Comments
Contract Details
Approval Date
1/2/2015
Contract Begin Date
4/1/2015
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
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
1/2/2015
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