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PROHEALTH RURAL HEALTH SERVICES
FQHCLA302 Prohealth Rural Health Services, Inc
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Covered Entity Details
Entity Name
Prohealth Rural Health Services, Inc
Subdivision Name
*
Type
Health Center Program Look-Alike
340B ID
FQHCLA302
Entity Address
1325 W. Main Street
Franklin, TN 37064-3786
Grant Number
LALCS00061
Participating Start Date
10/1/2012
Last Recertification Date
2/9/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
PROHEALTH RURAL HEALTH SERVICES
Pharmacy Address
1325 WEST MAIN STREET
FRANKLIN, TN 37064
Pharmacy Comments
Contract Details
Approval Date
7/3/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Ray White, President/CEO
(615) 866-6163
Contract Pharmacy Representative
Prohealth Rural Health Services
Ruth Marcia Sirgo, Pharmacy Director
(615) 591-4750 Ext: 1029
Signed By Date
7/3/2017
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