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BARNES PHARMACY
SCH110071-00 Appling General Hospital
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Covered Entity Details
Entity Name
Appling General Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110071-00
Entity Address
163 E Tollison Street
Baxley, GA 31513
Medicare Provider Number
110071
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
BARNES PHARMACY
Pharmacy Address
694 S MAIN ST
BAXLEY, GA 31513-0124
Pharmacy Comments
Contract Details
Approval Date
7/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/25/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Randall T Crawford, CEO
(912) 367-9841 Ext: 1202
Contract Pharmacy Representative
Barnes Pharmacy
Mark Barnes, R. Ph
(912) 367-7708
Signed By Date
7/3/2019
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