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THE MEDICINE CABINET OF ALMA
CAH111327-00 BACON COUNTY HEALTH SERVICES, INC. D/B/A BACON COUNTY HOSPITAL AND HEALTH SYSTEM
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Covered Entity Details
Entity Name
BACON COUNTY HEALTH SERVICES, INC. D/B/A BACON COUNTY HOSPITAL AND HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111327-00
Entity Address
302 S. WAYNE STREET
ALMA, GA 31510
Medicare Provider Number
111327
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE CABINET OF ALMA
Pharmacy Address
102 SOUTH PIERCE STREET
ALMA, GA 31510-3153
Pharmacy Comments
Contract Details
Approval Date
7/1/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Kyle Lott, COO/ Pharmacy Director
(912) 632-3849
Contract Pharmacy Representative
The Medicine Cabinet
Brandy Butler, COO
(912) 720-8203
Signed By Date
7/1/2021
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