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TENNESSEE CVS PHARMACY, L.L.C.
RRC440002-00 Jackson-Madison County General Hospital District dba Jackson-Madison County General Hospital
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Covered Entity Details
Entity Name
Jackson-Madison County General Hospital District dba Jackson-Madison County General Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440002-00
Entity Address
620 Skyline Drive
Jackson, TN 38301
Medicare Provider Number
440002
Participating Start Date
4/1/2018
Last Recertification Date
9/7/2018
Entity Termination Date
3/31/2019
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 2386
1405 N. HIGHLAND AVENUE
JACKSON, TN 38301
Pharmacy Comments
Contract Details
Approval Date
7/9/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
BOBBY ARNOLD, CEO
(731) 541-6730
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
7/9/2013
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