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TENNESSEE CVS PHARMACY, L.L.C.
CAH441303-00 THREE RIVERS HOSPITAL
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Covered Entity Details
Entity Name
THREE RIVERS HOSPITAL
Subdivision Name
Three Rivers Hospital
Type
Critical Access Hospital
340B ID
CAH441303-00
Entity Address
451 HWY 13 S
WAVERLY, TN 37185
Medicare Provider Number
441303
Participating Start Date
1/1/2021
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01741
406 W. MAIN ST.
WAVERLY, TN 37185
Pharmacy Comments
Contract Details
Approval Date
10/12/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Freda B. Russell, CEO/CNO
(931) 296-4203 Ext: 1100
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
10/12/2015
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