340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
TANNER RETAIL PHARMACY
DSH110015 TANNER MEDICAL CENTER/VILLA RICA
Print
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
TANNER RETAIL PHARMACY
Pharmacy Address
706 DIXIE ST STE 140
CARROLLTON, GA 30117-3859
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol S. Crews, CFO
(770) 812-9745
Contract Pharmacy Representative
Tanner Retail Pharmacy
Erin Howland, Pharmacy Manager
(770) 812-8222
Signed By Date
4/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session