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CROSSVILLE DRUGS INC
DSH010005 HH Health System - Marshall LLC
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Covered Entity Details
Entity Name
HH Health System - Marshall LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010005
Entity Address
2505 U.S. HIGHWAY 431
BOAZ, AL 35957
Medicare Provider Number
010005
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CROSSVILLE DRUGS INC
Pharmacy Address
15192 AL HIGHWAY 68
CROSSVILLE, AL 35962-3452
Pharmacy Comments
Contract Details
Approval Date
3/2/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GARY R. GORE, CEO
(256) 894-6611
Contract Pharmacy Representative
James Gardner, Owner
(256) 528-7124
Signed By Date
3/2/2016
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