Contract Pharmacy Details

DOUGLAS DISCOUNT PHARMACY
DSH010005 HH Health System - Marshall LLC

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

DOUGLAS DISCOUNT PHARMACY

Pharmacy Address

DOUGLAS DISCOUNT PHARMACY
9461 AL HIGHWAY 75
HORTON, AL 35980

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

Jim Gann, President
(256) 593-1750

Signed By Date

3/2/2016

340B Drug Pricing Program Database