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NORTH FL PHARMACY OF MAYO
CAH101314-00 Doctors Memorial Hospital, Inc.
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Covered Entity Details
Entity Name
Doctors Memorial Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101314-00
Entity Address
333 N BYRON BUTLER PKWY
Perry, FL 32347
Medicare Provider Number
101314
Participating Start Date
11/16/2023
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
NORTH FL PHARMACY OF MAYO
Pharmacy Address
PO BOX 1510
229 WEST MAIN STREET
MAYO, FL 32066-1510
Pharmacy Comments
Contract Details
Approval Date
11/16/2023
Contract Begin Date
11/16/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lauren Faison-Clark, CEO
(850) 584-0886
Contract Pharmacy Representative
North FLorida Pharmacy of Mayo, INC
VICKY NOLING, PRESIDENT/MANAGER
(386) 294-3777
Signed By Date
11/9/2023
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