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W.B. DRUGS
DSH110132 MEMORIAL HOSPITAL AND MANOR
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL AND MANOR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110132
Entity Address
1500 E SHOTWELL STREET
BAINBRIDGE, GA 39819
Medicare Provider Number
110132
Participating Start Date
10/1/2004
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
W.B. DRUGS
Pharmacy Address
RX DRUG CENTER
1205 E SHOTWELL ST
BAINBRIDGE, GA 39819-4237
Pharmacy Comments
Contract Details
Approval Date
10/9/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregg William Magers, Interim CEO
(229) 243-6109
Contract Pharmacy Representative
Rx Drug Center
Winston Burnum Brock, Jr., Pharmacist Owner
(229) 246-1000
Signed By Date
10/9/2017
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