Contract Pharmacy Details

SNEADS PHARMACY
DSH100142 JACKSON HOSPITAL

Covered Entity Details

Entity Name

JACKSON HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100142

Entity Address

4250 HOSPITAL DRIVE
MARIANNA, FL 32446

Medicare Provider Number

100142

Participating Start Date

4/1/2010

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

SNEADS PHARMACY

Pharmacy Address

7995 HIGHWAY 90
SNEADS, FL 32460

Pharmacy Comments

Contract Details

Approval Date

10/15/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/15/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

LARRY MEESE, CEO
(850) 718-2622

Contract Pharmacy Representative

Brian Lewis, Owner
(850) 593-5288

Signed By Date

10/15/2013