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ALH COMMUNITY PHARMACY
DSH010079B ATHENS-LIMESTONE
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Covered Entity Details
Entity Name
ATHENS-LIMESTONE
Subdivision Name
ATHENS LIMESTONE SURGERY TOWER - OUTPATIENT SURGERY
Type
Disproportionate Share Hospital
340B ID
DSH010079B
Entity Address
22454 US HWY 72
ATHENS, AL 35613
Medicare Provider Number
010079
Outpatient Facility Provider Number
Participating Start Date
3/15/2022
Last Recertification Date
8/22/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
ALH COMMUNITY PHARMACY
Pharmacy Address
700 W MARKET ST
ATHENS, AL 35611-2457
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JAMES R. COMER, CFO
(256) 233-9172
Contract Pharmacy Representative
Athens Limestone Hospital
JAMES R. COMER, CFO
(256) 233-9172
Signed By Date
4/12/2022
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