Contract Pharmacy Details

EASTMAN DRUGS INC
DSH110092 DODGE COUNTY HOSPITAL

Covered Entity Details

Entity Name

DODGE COUNTY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110092

Entity Address

901 GRIFFIN AVE
EASTMAN, GA 31023

Medicare Provider Number

110092

Participating Start Date

7/1/2006

Last Recertification Date

8/31/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

EASTMAN DRUGS INC

Pharmacy Address

1221 PLAZA AVE STE B
EASTMAN, GA 31023-9011

Pharmacy Comments

Contract Details

Approval Date

8/30/2012

Contract Begin Date

9/4/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/30/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

KEVIN Lynn BIERSCHENK, CFO
(478) 448-4067

Contract Pharmacy Representative

Kenneth Rogers, Manager / Owner
(478) 374-6670

Signed By Date

8/28/2012