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WAL-MART PHARMACY 10-3829
CH0413490 EAST TENNESSEE STATE UNIVERSITY
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Covered Entity Details
Entity Name
EAST TENNESSEE STATE UNIVERSITY
Subdivision Name
EAST TENNESSEE STATE UNIVERSITY COLLEGE OF NURSING
Type
HRSA-Funded Health Center
340B ID
CH0413490
Entity Address
400 JL Seehorn Road
JOHNSON CITY, TN 37614
Grant Number
H80CS00840
Participating Start Date
7/1/1995
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3829
Pharmacy Address
2915 WEST MARKET STREET
JOHNSON CITY, TN 37604
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Silas Tolan, Executive Director
(423) 439-4051
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2018
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