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PHOEBE SPECIALTY PHARMACY
DSH110044 PHOEBE SUMTER MEDICAL CENTER
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Covered Entity Details
Entity Name
PHOEBE SUMTER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110044
Entity Address
126 Hwy 280 West
AMERICUS, GA 31719
Medicare Provider Number
110044
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
PHOEBE SPECIALTY PHARMACY
Pharmacy Address
425 W 3RD AVE, MEDICAL TOWER 1
SUITE 100
ALBANY, GA 31701
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brandi Lee Lunneborg, Chief Executive Officer
(229) 931-1191
Contract Pharmacy Representative
Phoebe Putney Health Systems
Torey Alaine Jones, 340B Program Pharmacy Manager
(229) 312-2177
Signed By Date
4/14/2020
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