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TENNESSEE CVS PHARMACY, L.L.C.
CH041260 ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
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Covered Entity Details
Entity Name
ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
Subdivision Name
SOUTHSIDE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH041260
Entity Address
3800 Tennessee Ave.
Suite 124
CHATTANOOGA, TN 37409
Grant Number
H80CS00091
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11189
1200 DODSON AVENUE
CHATTANOOGA, TN 37406
Pharmacy Comments
Contract Details
Approval Date
10/5/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joe Winick, Sr. VP of Planning Business Development
(423) 778-8088
Contract Pharmacy Representative
CVS
Andrea Waldrop, Pharmacist in Charge
(423) 386-1107
Signed By Date
10/5/2017
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