340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
JACKSON HOSP & CLINIC INC
DSH010024 JACKSON HOSPITAL AND CLINIC INC
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010024
Entity Address
1725 PINE STREET
MONTGOMERY, AL 36106-1109
Medicare Provider Number
010024
Participating Start Date
9/7/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
JACKSON HOSP & CLINIC INC
Pharmacy Address
1725 PINE ST
MONTGOMERY, AL 36106-1109
Pharmacy Comments
Contract Details
Approval Date
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
LARRY SHERBETT, AVP-FINANCE
(334) 293-8820
Contract Pharmacy Representative
DAVID GRIFFIES, DIRECTOR OF PHARMACY
(334) 293-8780
Signed By Date
7/16/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session