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FRED'S PHARMACY # 1639
DSH010051 GREENE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GREENE COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010051
Entity Address
509 WILSON AVENUE
EUTAW, AL 35462
Medicare Provider Number
010051
Participating Start Date
10/1/2017
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY # 1639
Pharmacy Address
505 US HWY 80 WEST STE. A
DEMOPOLIS, AL 36732
Pharmacy Comments
Contract Details
Approval Date
7/12/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elmore Patterson, CEO
(205) 372-3388 Ext: 211
Contract Pharmacy Representative
Fred's Pharmacy
Nicole Pearson, 340B Program Manager
(901) 500-6153
Signed By Date
7/12/2017
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