340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GEORGE'S FAMILY PHARMACY, INC.
DSH150064 FAYETTE MEMORIAL HOSPITAL ASSOCIATION
Print
Covered Entity Details
Entity Name
FAYETTE MEMORIAL HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150064
Entity Address
1941 VIRGINIA AVENUE
CONNERSVILLE, IN 47331
Medicare Provider Number
150064
Participating Start Date
4/1/2010
Last Recertification Date
9/4/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
GEORGE'S FAMILY PHARMACY, INC.
Pharmacy Address
GEORGE'S FAMILY PHARMACY
24128 STATE LINE RD
LAWRENCEBURG, IN 47025
Pharmacy Comments
Contract Details
Approval Date
7/19/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Skip Smith, CFO
(765) 817-7989
Contract Pharmacy Representative
George's Family Pharmacy, Inc.
Blake Gillman, President & CEO
(765) 647-6251
Signed By Date
7/19/2013
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