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ESI MAIL PHARMACY SERVICE
DSH110001 HAMILTON MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
HAMILTON MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110001
Entity Address
1200 Memorial Dr
DALTON, GA 30720
Medicare Provider Number
110001
Participating Start Date
7/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randall Foster, Vice President-Finance
(706) 272-6124 Ext: 6124
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Senior Director 340B sales
(615) 943-7500
Signed By Date
4/18/2023
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