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ALMA DISCOUNT PHARMACY
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
ALMA DISCOUNT PHARMACY
Pharmacy Address
ALMA DISCOUNT PHARMACY
442 W 12TH ST
ALMA, GA 31510
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Kyle Lott, COO/ Pharmacy Director
(912) 632-3849
Contract Pharmacy Representative
Alma Discount Pharmacy
Eddie Butts, Owner
(912) 632-4267
Signed By Date
7/12/2021
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