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TANNER RETAIL PHARMACY
CAH011306-00 Tanner Medical Center Alabama, Inc.
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Covered Entity Details
Entity Name
Tanner Medical Center Alabama, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH011306-00
Entity Address
1032 South Main Street
Wedowee, AL 36278
Medicare Provider Number
011306
Participating Start Date
7/1/2019
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
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