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CVS TN DISTRIBUTION, LLC
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
CVS TN DISTRIBUTION, LLC
Pharmacy Address
10017 KINGSTON PIKE
KNOXVILLE, TN 37922
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
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 Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/10/2014
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