Contract Pharmacy Details

CORAM ALTERNATE SITE SERVICES, INC.
DSH110034 AU Medical Center, Inc.

Covered Entity Details

Entity Name

AU Medical Center, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110034

Entity Address

1120 15TH ST.
AUGUSTA, GA 30912

Medicare Provider Number

110034

Participating Start Date

12/1/1992

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

CORAM ALTERNATE SITE SERVICES, INC.

Pharmacy Address

CORAM CVS/SPECIALTY INFUSION SERVICES
2140 NEWMARKET PARKWAY
SUITE 106
MARIETTA, GA 30067-8767

Pharmacy Comments

Contract Details

Approval Date

7/11/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/17/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Lee Ann Liska, Chief Executive Officer
(706) 721-6569

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/11/2017

340B Drug Pricing Program Database