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BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
DSH110122 SOUTH GEORGIA MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110122
Entity Address
2501 NORTH PATTERSON STREET
VALDOSTA, GA 31602
Medicare Provider Number
110122
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
Pharmacy Address
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
145 S 79TH ST STE 70
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald E Dean, CEO
(229) 259-4102
Contract Pharmacy Representative
Bioplus
Bill Cook, Executive VP of Sales
(866) 840-4067
Signed By Date
10/7/2024
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