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CVS TN DISTRIBUTION, LLC
CAH341317-00 LifeBrite Hospital Group of Stokes, LLC dba LifeBrite Community Hospital of Stokes
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Covered Entity Details
Entity Name
LifeBrite Hospital Group of Stokes, LLC dba LifeBrite Community Hospital of Stokes
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341317-00
Entity Address
1570 NC 8 & 89 HWY N
Danbury, NC 27016
Medicare Provider Number
341317
Participating Start Date
7/1/2014
Last Recertification Date
11/7/2017
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
CVS TN DISTRIBUTION, LLC
Pharmacy Address
10017 KINGSTON PIKE
KNOXVILLE, TN 37922
Pharmacy Comments
Contract Details
Approval Date
10/6/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela P. Tillman, CEO
(336) 593-5314
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/6/2014
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