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LINCOLNTON INVESTMENTS LLC
CAH111325-00 WILLS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WILLS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111325-00
Entity Address
120 GORDON STREET
WASHINGTON, GA 30673
Medicare Provider Number
111325
Participating Start Date
10/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LINCOLNTON INVESTMENTS LLC
Pharmacy Address
DBA CRAWFORD & BREAZEALE DRUG CO.
125 N WASHINGTON ST
LINCOLNTON, GA 30817-1784
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tracie P. Haughey, CEO
(706) 678-9212
Contract Pharmacy Representative
Lincolnton Investments LLC, d/b/a Crawford & Breazeale Drug Co.
Bryce Allfrey, PIC/Managing Partner
(706) 359-3343
Signed By Date
1/3/2019
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