340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GEORGIA CVS PHARMACY, L.L.C.
DSH110011 TANNER MEDICAL CENTER
Print
Covered Entity Details
Entity Name
TANNER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110011
Entity Address
705 DIXIE STREET
CARROLLTON, GA 30117
Medicare Provider Number
110011
Participating Start Date
7/1/2024
Last Recertification Date
8/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07721
206 ALABAMA AVE,
BREMEN, GA 30110
Pharmacy Comments
Contract Details
Approval Date
5/6/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Carol S. Crews, CFO
(770) 812-9745
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
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