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ALH COMMUNITY PHARMACY #2
DSH010079 ATHENS-LIMESTONE
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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 #2
Pharmacy Address
22454 US HIGHWAY 72 STE 120
ATHENS, AL 35613-2609
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
ALH Community Pharmacy #2
Sara Tankersley, Pharmacist
(256) 262-6745
Signed By Date
4/14/2020
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