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JELLICO DRUG STORE INC
CH04216A DAYSPRING HEALTH, INC.
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Covered Entity Details
Entity Name
DAYSPRING HEALTH, INC.
Subdivision Name
DAYSPRING JELLICO
Type
HRSA-Funded Health Center
340B ID
CH04216A
Entity Address
550 Sunset Trl
Jellico, TN 37762-2343
Grant Number
H80CS00716
Participating Start Date
10/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
JELLICO DRUG STORE INC
Pharmacy Address
JELLICO DRUG INC
229 S MAIN ST
JELLICO, TN 37762-2018
Pharmacy Comments
Contract Details
Approval Date
8/31/2005
Contract Begin Date
8/31/2005
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/31/2005
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