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H & S PHARMACY NO 2 INC
CAH441309-00 MARSHALL MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHALL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH441309-00
Entity Address
1080 NORTH ELLINGTON PKWY
LEWISBURG, TN 37091
Medicare Provider Number
441309
Participating Start Date
9/21/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
H & S PHARMACY NO 2 INC
Pharmacy Address
850 N. ELLINGTON PARKWAY
P.O. BOX 2606
LEWISBURG, TN 37091
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/15/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
PHYLLIS BROWN, CHIEF EXECUTIVE OFFICER
(931) 359-6241 Ext: 3306
Contract Pharmacy Representative
Franklin Crigger, Partner/Secretary
(931) 359-4094
Signed By Date
9/5/2012
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