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BLOUNTSTOWN DRUG INC
CAH101304-00 CALHOUN-LIBERTY HOSPITAL
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Covered Entity Details
Entity Name
CALHOUN-LIBERTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101304-00
Entity Address
20370 NE BURNS AVENUE
BLOUNTSTOWN, FL 32424
Medicare Provider Number
101304
Participating Start Date
8/10/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
BLOUNTSTOWN DRUG INC
Pharmacy Address
20370 CENTRAL AVE W
BLOUNTSTOWN, FL 32424
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHILLIP HILL, ADMINISTRATOR
(850) 674-5411 Ext: 206
Contract Pharmacy Representative
corporation
Jon Plummer, Owner
(850) 674-2222
Signed By Date
1/15/2014
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