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H & W APOTHECARY
SCH010109-00 PICKENS COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
PICKENS COUNTY MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH010109-00
Entity Address
241 ROBERT K WILSON DRIVE
CARROLLTON, AL 35447
Medicare Provider Number
010109
Participating Start Date
1/1/2019
Last Recertification Date
8/28/2019
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
H & W APOTHECARY
Pharmacy Address
211 1ST ST S
REFORM, AL 35481-8017
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard McBryde, CFO
(205) 367-8111
Contract Pharmacy Representative
Pickens County Medical Center
David Handley, President
(205) 367-2476
Signed By Date
7/11/2019
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