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CORAM ALTERNATE SITE SERVICES, INC.
DSH100135 TALLAHASSEE MEMORIAL HEALTHCARE, INC
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Covered Entity Details
Entity Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100135
Entity Address
1300 MICCOSUKEE ROAD
TALLAHASSEE, FL 32308
Medicare Provider Number
100135
Participating Start Date
1/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CORAM ALTERNATE SITE SERVICES, INC.
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
3439 NORTH 12TH AVENUE
SUITE A AND B
PENSACOLA, FL 32503-4008
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Priscilla Needham, Chief Financial Officer
(850) 431-0630
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2023
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