Contract Pharmacy Details

LATHAM'S PHARMACY
RRC010005-00 MARSHALL MEDICAL CENTER SOUTH

Covered Entity Details

Entity Name

MARSHALL MEDICAL CENTER SOUTH

Subdivision Name

Type

Rural Referral Center

340B ID

RRC010005-00

Entity Address

2505 US HIGHWAY 431 NORTH
BOAZ, AL 35957

Medicare Provider Number

010005

Participating Start Date

7/1/2011

Last Recertification Date

8/5/2015

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

LATHAM'S PHARMACY

Pharmacy Address

PARRISH INC.
178 S MAIN ST
ARAB, AL 35016

Pharmacy Comments

Contract Details

Approval Date

1/13/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

GARY R. GORE, CEO
(256) 894-6611

Contract Pharmacy Representative

Steve Parrish, Pharmacist/ Owner
(256) 586-4132

Signed By Date

1/13/2014