340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LOUISVILLE DRUG CO
SCH110100-00 JEFFERSON HOSPITAL
Print
Covered Entity Details
Entity Name
JEFFERSON HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110100-00
Entity Address
1067 PEACHTREE STREET
LOUISVILLE, GA 30434-1558
Medicare Provider Number
110100
Participating Start Date
7/1/2019
Last Recertification Date
8/21/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
LOUISVILLE DRUG CO
Pharmacy Address
LOUISVILLE DRUG COMPANY
101 E BROAD ST
LOUISVILLE, GA 30434
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
MATT CLARK, CFO/CONTROLLER
(478) 625-7000 Ext: 208
Contract Pharmacy Representative
Louisville Drug
Gloria Machalk, Pharmacist / Owner
(478) 625-7575
Signed By Date
10/15/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session