340B Drug Pricing Program Database
RIVER MEDICAL PHARMACY LLC
DSH110044 PHOEBE SUMTER MEDICAL CENTER - information as of 4/27/2025 1:22:41 AM
Covered Entity Details
Entity Name
PHOEBE SUMTER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110044
Entity Address
126 Hwy 280 West
AMERICUS, GA 31719
Medicare Provider Number
110044
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
RIVER MEDICAL PHARMACY LLC
Pharmacy Address
4752 RESEARCH DR
SAN ANTONIO, TX 78240-5002
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRANDI LUNNEBORG, CEO
(229) 931-1280
Contract Pharmacy Representative
CarepathRx Health System Solution
Ryan Rushing, Vice President, 340B Solutions
(512) 541-0665
Signed By Date
1/15/2020
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