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GOLDEN PHARMACY 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
GOLDEN PHARMACY INC
Pharmacy Address
17324 MAIN ST N
BLOUNTSTOWN, FL 32424
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nathan Ebersole, CFO
(850) 674-5411 Ext: 219
Contract Pharmacy Representative
Clifford Goodman, President
(850) 674-4557
Signed By Date
7/14/2016
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