Contract Pharmacy Details

IHS PHARMACY
CAH111334-00 Candler County Hospital

Covered Entity Details

Entity Name

Candler County Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH111334-00

Entity Address

400 Cedar Street
Metter, GA 30439

Medicare Provider Number

111334

Participating Start Date

4/1/2014

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

IHS PHARMACY

Pharmacy Address

150 S LEROY ST
METTER, GA 30439-4631

Pharmacy Comments

Contract Details

Approval Date

10/2/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Damien Scott, CEO
(912) 685-1704 Ext: 1799

Contract Pharmacy Representative

IHS Pharmacy
Dean Stone, Owner
(912) 685-2803

Signed By Date

10/2/2014