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FOOD CITY PHARMACY #663
RRC440025-00 LAUGHLIN MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
LAUGHLIN MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440025-00
Entity Address
1420 TUSCULUM BLVD.
GREENEVILLE, TN 37745-5825
Medicare Provider Number
440025
Participating Start Date
4/1/2013
Last Recertification Date
8/16/2016
Entity Termination Date
1/1/2018
Pharmacy Details
Pharmacy Name
FOOD CITY PHARMACY #663
Pharmacy Address
2755 E. ANDREW JOHNSON HIGHWAY
GREENEVILLE, TN 37745
Pharmacy Comments
Contract Details
Approval Date
4/1/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JOHN MARK COMPTON, CFO
(423) 787-5077
Contract Pharmacy Representative
Lara Denton-Ayres, Pharmacy Manager
(423) 525-4221
Signed By Date
4/1/2014
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