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BOONE'S PHARMACY
DSH010112 Whitfield Regional Hospital
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Covered Entity Details
Entity Name
Whitfield Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010112
Entity Address
105 US HIGHWAY 80 EAST
DEMOPOLIS, AL 36732
Medicare Provider Number
010112
Participating Start Date
4/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BOONE'S PHARMACY
Pharmacy Address
951 US HIGHWAY 80 W
DEMOPOLIS, AL 36732-4156
Pharmacy Comments
Contract Details
Approval Date
10/1/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Brooker, CFO
(334) 287-2529
Contract Pharmacy Representative
Boone's Pharmacy
Raymond Boone, Owner
(334) 289-8989
Signed By Date
10/1/2020
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