Contract Pharmacy Details

U-SAVE-IT PHARMACY
DSH110104 CRISP REGIONAL HOSPITAL, INC.

Covered Entity Details

Entity Name

CRISP REGIONAL HOSPITAL, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110104

Entity Address

902 7TH STREET NORTH
CORDELE, GA 31015-5007

Medicare Provider Number

110104

Participating Start Date

1/1/2005

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

U-SAVE-IT PHARMACY

Pharmacy Address

405 4TH AVE EAST
CORDELE, GA 31015

Pharmacy Comments

Contract Details

Approval Date

4/19/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/17/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jessica Carter, CFO
(229) 276-3130

Contract Pharmacy Representative

Paula Norman, Executive Vice President
(229) 435-2050

Signed By Date

4/19/2013

340B Drug Pricing Program Database