340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DALTON PHARMACY
DSH010001 SOUTHEAST HEALTH MEDICAL CENTER
Print
Covered Entity Details
Entity Name
SOUTHEAST HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010001
Entity Address
1108 ROSS CLARK CIRCLE
DOTHAN, AL 36301
Medicare Provider Number
010001
Participating Start Date
7/1/2024
Last Recertification Date
8/26/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
DALTON PHARMACY
Pharmacy Address
141 S DALTON ST
PO BOX 279
SLOCOMB, AL 36375
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DEREK R. MILLER, SR. VP FINANCE, CFO
(334) 793-8815
Contract Pharmacy Representative
Dalton Pharmacies
Joe A. Dalton, President & Owner
(334) 797-7992
Signed By Date
4/10/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session