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ENCOMPASS RX, LLC
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
ENCOMPASS RX, LLC
Pharmacy Address
2700 NORTHEAST EXPRESSWAY
SUITE B-800
ATLANTA, GA 30345
Pharmacy Comments
Contract Details
Approval Date
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2022
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
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
1/18/2021
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