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ERLANGER PHARMACIES
DSH440104C Erlanger Health
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Covered Entity Details
Entity Name
Erlanger Health
Subdivision Name
PACC Ambulatory Surgery
Type
Disproportionate Share Hospital
340B ID
DSH440104C
Entity Address
975 East Third Street
Chattanooga, TN 37403
Medicare Provider Number
440104
Outpatient Facility Provider Number
Participating Start Date
4/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
ERLANGER PHARMACIES
Pharmacy Address
DBA ERLANGER PHARMACY
979 EAST THIRD ST. SUITE 120
CHATTANOOGA, TN 37403
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
Donna Bourdon, President
(423) 386-1017
Signed By Date
4/15/2013
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