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CARTER'S PHARMACY
DSH110024 CANDLER HOSPITAL
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Covered Entity Details
Entity Name
CANDLER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110024
Entity Address
5353 REYNOLDS STREET
SAVANNAH, GA 31405
Medicare Provider Number
110024
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CARTER'S PHARMACY
Pharmacy Address
CARTER'S PHAMACY,INC
STE.#10
1017 E. HIGHWAY 80
POOLER, GA 31322
Pharmacy Comments
Contract Details
Approval Date
4/20/2012
Contract Begin Date
4/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/16/2017
Ownership change
Contacts
Covered Entity Signing Official
Paul P. Hinchey, CEO
(912) 819-6901
Contract Pharmacy Representative
Carter's Phamacy,Inc
Amy C Carter, Owner
(912) 748-1414
Signed By Date
4/20/2012
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