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THE MEDICINE CABINET OF ALMA
DSH110089 COFFEE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110089
Entity Address
1101 OCILLA ROAD
DOUGLAS, GA 31533
Medicare Provider Number
110089
Participating Start Date
4/1/2007
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE CABINET OF ALMA
Pharmacy Address
102 SOUTH PIERCE STREET
ALMA, GA 31510-3153
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BARRY BLOOM, VP/CONTROLLER
(912) 383-5621
Contract Pharmacy Representative
The Medicine Cabinet of Douglas, LLC
Scott Meeks, Owner
(912) 383-8510
Signed By Date
1/14/2015
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