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THE MEDICINE CABINET OF BRUNSWICK, LLC
SCH110025-00 SOUTHEAST GEORGIA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHEAST GEORGIA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110025-00
Entity Address
2415 PARKWOOD DRIVE
BRUNSWICK, GA 31520
Medicare Provider Number
110025
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE CABINET OF BRUNSWICK, LLC
Pharmacy Address
2500 STARLING ST STE 102
BRUNSWICK, GA 31520-4266
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryon Scott Raynes, President and CEO
(912) 466-7049
Contract Pharmacy Representative
The Medicine Cabinet
Brandy Butler, COO
(912) 720-8203
Signed By Date
10/14/2024
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