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BOONE'S PHARMACY
DSH010051 GREENE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GREENE COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010051
Entity Address
509 WILSON AVENUE
EUTAW, AL 35462
Medicare Provider Number
010051
Participating Start Date
10/1/2017
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BOONE'S PHARMACY
Pharmacy Address
850 D TUSCALOOSA STREET
GREENSBORO, AL 36744
Pharmacy Comments
Contract Details
Approval Date
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcia Pugh, CEO
(205) 372-3388 Ext: 211
Contract Pharmacy Representative
Boone's Pharmacy
Raymond Boone, Owner
(334) 289-8989
Signed By Date
10/11/2022
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