Contract Pharmacy Details

ALH COMMUNITY PHARMACY
DSH010079 ATHENS-LIMESTONE

Covered Entity Details

Entity Name

ATHENS-LIMESTONE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010079

Entity Address

700 WEST MARKET STREET
ATHENS, AL 35611

Medicare Provider Number

010079

Participating Start Date

3/15/2022

Last Recertification Date

9/8/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

ALH COMMUNITY PHARMACY

Pharmacy Address

700 W MARKET ST
ATHENS, AL 35611-2457

Pharmacy Comments

Contract Details

Approval Date

4/14/2020

Contract Begin Date

3/15/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

JAMES R. COMER, CFO
(256) 233-9172

Contract Pharmacy Representative

Athens Limestone Hospital
JAMES R. COMER, CFO
(256) 233-9172

Signed By Date

4/14/2020