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H & S PHARMACY #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 #2, INC
Pharmacy Address
H & S PHARMACY #1
521 WEST COMMERCE STREET
LEWISBURG, TN 37091
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Ownership change
Contacts
Covered Entity Signing Official
PHYLLIS BROWN, CHIEF EXECUTIVE OFFICER
(931) 359-6241 Ext: 3306
Contract Pharmacy Representative
Franklin Crigger, owner
(931) 359-7319
Signed By Date
1/17/2017
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