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JELLICO DRUG STORE INC
CH042160 DAYSPRING HEALTH, INC.
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Covered Entity Details
Entity Name
DAYSPRING HEALTH, INC.
Subdivision Name
DAYSPRING HEALTH, INC.
Type
HRSA-Funded Health Center
340B ID
CH042160
Entity Address
107 S Main St
Jellico, TN 37762-2154
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
1/20/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark W. Watt, CEO
(423) 784-8492
Contract Pharmacy Representative
John Baird, Owner
(423) 784-6226
Signed By Date
1/20/2014
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