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ROSS DRUG
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
ROSS DRUG
Pharmacy Address
127 NORTH MAIN STREET
P.O. BOX 119
SYLVANIA, GA 30467
Pharmacy Comments
Contract Details
Approval Date
1/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAUL P. HINCHEY, CEO
(912) 819-6901
Contract Pharmacy Representative
Virgil Ross, President
(912) 564-7002
Signed By Date
1/5/2015
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