Contract Pharmacy Details

FOOD CITY PHARMACY #606
RRC440025-00 LAUGHLIN MEMORIAL HOSPITAL, INC.

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 #606

Pharmacy Address

905 SNAPPS FERRY ROAD
GREENEVILLE, TN 37745

Pharmacy Comments

Contract Details

Approval Date

1/4/2016

Contract Begin Date

4/1/2016

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

Food City
Connie Reed, Administrative Assistant
(276) 623-5100 Ext: 5738

Signed By Date

1/4/2016

340B Drug Pricing Program Database