Contract Pharmacy Details

RITE AID OF TENNESSEE, INC.
CH04216A DAYSPRING HEALTH, INC.

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

RITE AID OF TENNESSEE, INC.

Pharmacy Address

RITE AID #1935
289 NORTH MAIN STREET
JELLICO, TN 37762

Pharmacy Comments

Contract Details

Approval Date

4/8/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark W. Watt, CEO
(423) 784-8492

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

4/8/2013

340B Drug Pricing Program Database