340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
TENNESSEE CVS PHARMACY, L.L.C.
RRC440017-07 HOLSTON VALLEY HOSP & MED CTR
Print
Covered Entity Details
Entity Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
WELLMONT CANCER INSTITUTE JOHNSON CITY / INFUSION SERVICES
Type
Rural Referral Center
340B ID
RRC440017-07
Entity Address
378 MARKET BLVD
SUITE 11
JOHNSON CITY, TN 37604
Medicare Provider Number
440017
Outpatient Facility Provider Number
Participating Start Date
4/1/2017
Last Recertification Date
11/9/2017
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05664
4106 FT. HENRY DR.
KINGSPORT, TN 37663
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Todd j. Dougan, CFO
(423) 230-8512
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session