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WAL-MART PHARMACY 10-0678
CH04681A RURAL MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
RURAL MEDICAL SERVICES, INC.
Subdivision Name
PARROTTSVILLE CENTER
Type
HRSA-Funded Health Center
340B ID
CH04681A
Entity Address
111 Mockingbird Ave
Parrottsville, TN 37843-2741
Grant Number
H80CS00406
Participating Start Date
12/1/1992
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0678
Pharmacy Address
1075 COSBY HIGHWAY
NEWPORT, TN 37821
Pharmacy Comments
Contract Details
Approval Date
3/22/2018
Contract Begin Date
3/22/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LARRY STANIFER, CEO
(423) 613-3300
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
3/22/2018
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