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US BIOSERVICES
DSH190034 ABBEVILLE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190034
Entity Address
118 NORTH HOSPITAL DRIVE
ABBEVILLE, LA 70510
Medicare Provider Number
190034
Participating Start Date
9/15/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
US BIOSERVICES
Pharmacy Address
PHARM PLUS ACQUISITION, INC.
5100 E HUNTER AVE
SUITE 101
ANAHEIM, CA 92807-2049
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ray Landry, CEO
(337) 898-6500
Contract Pharmacy Representative
US Bioservices Corporation
Mischelle Smoot, Pharmacist in Charge
(888) 518-7246
Signed By Date
10/15/2019
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