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DOGWOOD PHARMACY LLC
DSH110015 TANNER MEDICAL CENTER/VILLA RICA
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Covered Entity Details
Entity Name
TANNER MEDICAL CENTER/VILLA RICA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110015
Entity Address
601 DALLAS ROAD
VILLA RICA, GA 30180
Medicare Provider Number
110015
Participating Start Date
7/1/2005
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
DOGWOOD PHARMACY LLC
Pharmacy Address
D/B/A MEDSCRIPTS MEDICAL PHARMACY
1325 MILLER RD
STE K
GREENVILLE, SC 29607-6541
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol S. Crews, CFO
(770) 812-9745
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
10/16/2023
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