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MAXOR SPECIALTY PHARMACY
DSH440104 Erlanger Health
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Covered Entity Details
Entity Name
Erlanger Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440104
Entity Address
975 East Third Street
CHATTANOOGA, TN 37403
Medicare Provider Number
440104
Participating Start Date
12/1/1992
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
MAXOR SPECIALTY PHARMACY
Pharmacy Address
150 CLEVELAND RD
SUITE B
BOGART, GA 30622-1701
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
7/28/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRITTON J. TABOR, CFO
(423) 778-7729
Contract Pharmacy Representative
Maxor
Suzanne Hansen, Executive VP of Operations
(806) 242-7212
Signed By Date
7/15/2020
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