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A & H DRUG, LLC
DSH110130 IRWIN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
IRWIN COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110130
Entity Address
710 NORTH IRWIN AVENUE
OCILLA, GA 31774
Medicare Provider Number
110130
Participating Start Date
7/1/2017
Last Recertification Date
8/31/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
A & H DRUG, LLC
Pharmacy Address
WILLS DRUG CO
615 N IRWIN AVE
THE MEDICINE CABINET OF OCILLA
OCILLA, GA 31774-5009
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paige Wynn, COO / CFO
(229) 468-3845
Contract Pharmacy Representative
A & H Drug, LLC
Alex Wills, Owner
(912) 381-5712
Signed By Date
4/13/2022
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