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RAINBOW DRUG STORE
DSH110146 Southeast Georgia Health System Camden Campus
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Covered Entity Details
Entity Name
Southeast Georgia Health System Camden Campus
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110146
Entity Address
2000 DAN PROCTOR DRIVE
SAINT MARYS, GA 31558
Medicare Provider Number
110146
Participating Start Date
11/29/2022
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
RAINBOW DRUG STORE
Pharmacy Address
4319 NEW JESUP HWY
BRUNSWICK, GA 31520-1605
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
11/29/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL D. SCHERNECK, PRESIDENT, CEO
(912) 466-7049
Contract Pharmacy Representative
Rainbow PSA
Richard Griffis, Chief Operating Officer
(912) 265-1793
Signed By Date
10/15/2019
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