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MARTIN'S PHARMACY #6426
SCH490018-00 AUGUSTA MEDICAL CENTER
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Covered Entity Details
Entity Name
AUGUSTA MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490018-00
Entity Address
78 MEDICAL CENTER DRIVE
FISHERSVILLE, VA 22939
Medicare Provider Number
490018
Participating Start Date
7/1/2020
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
MARTIN'S PHARMACY #6426
Pharmacy Address
1015 RICHMOND ROAD
STAUNTON, VA 24401
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen C Clark, Vice President of Operations
(540) 332-4800
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
7/7/2021
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