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CARROLLTON DRUGS, INC
DSH010109 PICKENS COUNTY HEALTH CARE AUTHORITY
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Covered Entity Details
Entity Name
PICKENS COUNTY HEALTH CARE AUTHORITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010109
Entity Address
241 ROBERT K WILSON DRIVE
CARROLLTON, AL 35447
Medicare Provider Number
010109
Participating Start Date
7/1/2004
Last Recertification Date
11/29/2017
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
CARROLLTON DRUGS, INC
Pharmacy Address
25700 HIGHWAY 17
CARROLLTON, AL 35447
Pharmacy Comments
Contract Details
Approval Date
7/28/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jim Marshall, ADMINISTRATOR
(205) 367-8111 Ext: 114
Contract Pharmacy Representative
Pickens County Medical Center
David Handley, President
(205) 367-2476
Signed By Date
7/28/2017
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