Contract Pharmacy Details

U-SAVE-IT PHARMACY
DSH110104 CRISP REGIONAL HOSPITAL, INC.

Covered Entity Details

Entity Name

CRISP REGIONAL HOSPITAL, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110104

Entity Address

902 7TH STREET NORTH
CORDELE, GA 31015-5007

Medicare Provider Number

110104

Participating Start Date

1/1/2005

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

U-SAVE-IT PHARMACY

Pharmacy Address

405 4TH AVE EAST
CORDELE, GA 31015

Pharmacy Comments

Contract Details

Approval Date

4/18/2022

Contract Begin Date

5/24/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jessica Carter, CFO
(229) 276-3130

Contract Pharmacy Representative

U-Save-It
Ashley H Kunkle, Pharmacist Manager
(229) 669-3511

Signed By Date

4/18/2022

340B Drug Pricing Program Database