OrganizationK Va T Food Stores Inc(Food City Pharmacy 612)PharmacySuppliersPractice Address1287 E Main St, Rogersville, TN 37857-6922(423) 272-3790(276) 623-5100PECOS EnrollmentBased on the most recent information from CMS, provider K Va T Food Stores Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1700034022Provider TypeOrganizationFull NameK Va T Food Stores IncOther NameFood City Pharmacy 612SubpartNoEnumeration Date8/28/2008Last Updated3/16/2010Contact InformationPractice LocationPractice Address1287 E Main St, Rogersville, TN 37857-6922Phone(423) 272-3790Fax(423) 272-3940Mailing LocationMailing AddressPO Box 1158, Abingdon, VA 24212-1158Phone(276) 623-5100Fax(276) 623-5440Authorized OfficialNameSmith, Steven C (Chairman President Ceo)Phone(276) 623-5100Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicenseUnlisted IssuerCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1510116DescriptionOtherIssuerTENNCARE CROSSOVERTennesseeID4441630DescriptionOtherIssuerNCPDPID357534DescriptionOtherIssuerANTHEM BLUE CROSS BLUE SHIELD MEDIGAPID4198608DescriptionOtherIssuerBLUE CROSS BLUE SHIELD OF TNTennesseeID600002658DescriptionOtherIssuerRAILROAD MEDICARESouth Dakota