340B Drug Pricing Program Database

Pharmacy Name

MOUNTAIN CITY PHARMACY

Pharmacy Address

1641 S SHADY ST
MOUNTAIN CITY, TN 37683

Pharmacy Comments

Approval Date

9/30/2010

Contract Begin Date

9/30/2010

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901

Contract Pharmacy Representative

SAM B. ADAMS, PHARMACIST IN CHARGE
(423) 727-0039

Signed By Date

9/24/2010