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MARTIN'S PHARMACY #6285
SCH490018-00 AUGUSTA MEDICAL CENTER
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Covered Entity Details
Entity Name
AUGUSTA MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490018-00
Entity Address
78 MEDICAL CENTER DRIVE
FISHERSVILLE, VA 22939
Medicare Provider Number
490018
Participating Start Date
7/1/2020
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
MARTIN'S PHARMACY #6285
Pharmacy Address
437 TIFFANY DRIVE
WAYNESBORO, VA 22980
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Crabtree, Vice President of Professional Services
(540) 332-4800
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
4/11/2023
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