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GRAVES PHARMACY
DSH110107 Atrium Health Navicent The Medical Center
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Covered Entity Details
Entity Name
Atrium Health Navicent The Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110107
Entity Address
777 HEMLOCK ST.
MACON, GA 31201-2102
Medicare Provider Number
110107
Participating Start Date
12/1/1992
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
GRAVES PHARMACY
Pharmacy Address
770 PINE ST STE 100
MACON, GA 31201-7565
Pharmacy Comments
Contract Details
Approval Date
4/19/2012
Contract Begin Date
4/19/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/16/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rhonda S. Perry, Vice President / CFO
(478) 633-1000
Contract Pharmacy Representative
David Graves, Owner
(478) 745-0476
Signed By Date
4/24/2012
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