340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HOSPITAL DISCOUNT DRUG CENTER
DSH110089 COFFEE REGIONAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110089
Entity Address
1101 OCILLA ROAD
DOUGLAS, GA 31533
Medicare Provider Number
110089
Participating Start Date
4/1/2007
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
HOSPITAL DISCOUNT DRUG CENTER
Pharmacy Address
HOSPITAL DISCOUNT DRUGS
308 WESTSIDE DR
DOUGLAS, GA 31533-3153
Pharmacy Comments
Contract Details
Approval Date
4/17/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lavonda Cravey, VP Corporate Revenue
(912) 383-5600
Contract Pharmacy Representative
Westside Drugs, Inc.
Darrel Carter, Pharmacist/Owner
(912) 384-0693
Signed By Date
4/17/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session