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RITE AID OF TENNESSEE, INC.
DSH440131 BAPTIST MEMORIAL HOSPITAL- TIPTON
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL- TIPTON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440131
Entity Address
1995 HIGHWAY 51 S
COVINGTON, TN 38019-2338
Medicare Provider Number
440131
Participating Start Date
9/4/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
RITE AID OF TENNESSEE, INC.
Pharmacy Address
RITE AID #7410
605 HIGHWAY 51 NORTH
COVINGTON, TN 38019
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Monique Hart, Chief Finanacial Officer
(901) 475-5526
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/15/2014
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