Covered Entity Details

DSH010092 DCH REGIONAL MEDICAL CENTER (Active) - information as of 5/6/2025 11:02:35 PM

Main Details

Name

DCH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010092

Medicare Provider Number

010092

Additional Details

Current Program Status

Active

Registration Date

8/23/2007

Participating Start Date

1/1/2004

Participating Approval Date

8/23/2007

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

DCH Regional Medical Center
Mallary Marie Myers, COO/SVP
(205) 759-7147

Primary Contact

DCH Regional Medical Center
Rosanne Austin Thurman, Corporate Director, Pharmacy
(205) 759-7944

Addresses

Street Address

809 UNIVERSITY BOULEVARD EAST
TUSCALOOSA, AL 35401

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MS	00020414	1841394418
FL	090903300	1841394418
GA	000108292A	1841394418
TN	0010092	1841394418
AL	HOS0092H	1841394418,1073175840,1346006483

Shipping Addresses

Shipping Address 1

DCH Regional Medical Center
809 University Blvd East
Tuscaloosa, AL 35401

Shipping Address 2

Northport Medical Center
2700 Hospital Drive
Northport, AL 35476

Shipping Address 3

DCH Pharmacy at DCH Medical Tower
701 University Blvd EAst
M04
Tuscaloosa, AL 35401-7422

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04835	1910 MCFARLAND BOULEVARD	NORTHPORT	AL	35476	03/13/2012	03/13/2012	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04372	4280 MITT LARY RD.	NORTHPORT	AL	35475	03/13/2012	03/13/2012	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03004	8700 HWY 69 SOUTH	TUSCALOOSA	AL	35405	03/13/2012	03/13/2012	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04969	536 HUDSON DR., PO BOX 653	GORDO	AL	35466	03/13/2012	03/13/2012	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04819	808 VETERANS MEMORIAL PKWY	TUSCALOOSA	AL	35404	03/13/2012	03/13/2012	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04813	4260 UNIVERSITY BLVD EAST	TUSCALOOSA	AL	35404	11/20/2012	01/01/2013	03/05/2020	04/15/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07217	4715 RICE MINE RD. NE	TUSCALOOSA	AL	35406	07/01/2013	10/01/2013	03/05/2020	04/15/2021
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	01/14/2015	04/01/2015	04/01/2021	04/15/2021
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/10/2017	01/01/2018	07/13/2020	07/15/2020
Contract Detail	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	01/14/2015	04/01/2015	06/01/2020	06/15/2020
Contract Detail	BOLLING PHARMACY, INC.	101 TEMPLE AVE. S.		FAYETTE	AL	35555-2711	01/12/2012	01/12/2012	11/01/2021	11/01/2021
Contract Detail	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	07/17/2017	10/01/2017	07/13/2020	10/01/2017
Contract Detail	BRIOVARX OF MASSACHUSETTS, LLC	D/B/A BRIOVARX	BLDG 2 - UNIT A 145 BODWELL STREET	AVON	MA	02322	07/17/2017	10/01/2017	07/13/2020	10/01/2017
Contract Detail	DCH OUTPATIENT PHARMACY	DCH PHARMACY AT DCH MEDICAL TOWER	701 UNIVERSITY BLVD E STE M04	TUSCALOOSA	AL	35401-7422	07/15/2019	10/01/2019	10/01/2019	10/24/2019
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/15/2019	10/01/2019	04/01/2021	04/15/2021
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/17/2017	10/01/2017	04/01/2021	04/15/2021
Contract Detail	OPTUM INFUSION SERVICES 206, INC.	500 PAUL W BRYANT DR E STE B		TUSCALOOSA	AL	35401-2652	07/14/2020	10/01/2020	04/01/2021	04/15/2021
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/14/2020	10/01/2020	04/01/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/17/2017	10/01/2017	04/01/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/17/2017	10/01/2017	04/01/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/17/2017	10/01/2017	04/01/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 805, INC	1101 N CENTRAL AVE, STE 102		PHOENIX	AZ	85004-1829	07/15/2020	10/01/2020	04/01/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	07/14/2020	10/01/2020	04/01/2021	04/15/2021
Contract Detail	PUBLIX ALABAMA	PUBLIX PHARMACY #1075	2300 MCFARLAND BLVD	NORTHPORT	AL	35476	04/20/2023	07/01/2023	11/01/2024	11/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1253	1101 SOUTHVIEW LANE	TUSCALOOSA	AL	35405	04/20/2023	07/01/2023	11/01/2024	11/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #0075	4851 RICE MINE RD NE SUITE 200	TUSCALOOSA	AL	35406	04/20/2023	07/01/2023	11/01/2024	11/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1691	13556 HWY 69 N	NORTHPORT	AL	35475	04/20/2023	07/01/2023	11/01/2024	11/01/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/20/2023	07/01/2023		07/01/2023
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/20/2023	07/01/2023		07/01/2023
Contract Detail	WAL-MART PHARMACY 10-0715	1501 SKYLAND BLVD EAST		TUSCALOOSA	AL	35405	01/14/2015	04/01/2015	09/21/2020	04/15/2021
Contract Detail	WAL-MART PHARMACY 10-2306	5710 MCFARLAND BLVD		NORTHPORT	AL	35476	01/14/2015	04/01/2015	09/21/2020	04/15/2021
Contract Detail	WALGREEN CO	DBA: WALGREENS #11404	4400 UNIVERSITY BLVD E	TUSCALOOSA	AL	35404-5104	02/12/2013	04/01/2013		10/28/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05861	3107 LURLEEN B WALLACE BLVD	NORTHPORT	AL	35476	02/12/2013	04/01/2013		10/28/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10525	8701 HIGHWAY 69 S	TUSCALOOSA	AL	35405-8465	02/12/2013	04/01/2013		10/28/2016
Contract Detail	WALGREEN CO.	JIM MYERS A WALGREENS PHARMACY #15448	3325 UNIVERSITY BLVD EAST	TUSCALOOSA	AL	35404	03/06/2013	04/01/2013	05/20/2019	06/21/2019
Contract Detail	WALGREEN CO.	JIM MYERS A WALGREENS PHARMACY #15449	1520 MCFARLAND BLVD N SUITE B	TUSCALOOSA	AL	35406	03/06/2013	04/01/2013		10/28/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15450	701 UNIVERSITY BLVD E M-04	TUSCALOOSA	AL	35401	03/06/2013	04/01/2013	10/02/2019	10/02/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15451	2731 MARTIN LUTHER KING BLVD SUITE C	TUSCALOOSA	AL	35401	03/06/2013	04/01/2013	06/08/2022	08/19/2022
Contract Detail	WALGREEN CO.	WALGREENS #17955	3206 15TH ST	TUSCALOOSA	AL	35401-4002	10/15/2021	01/01/2022	03/25/2025	03/25/2025
Contract Detail	WALGREEN CO.	WALGREENS #18125	4200 MCFARLAND BLVD E STE 6	TUSCALOOSA	AL	35405	10/15/2021	01/01/2022		01/01/2022
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/10/2022	01/01/2023		01/01/2023
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/12/2013	07/01/2013	06/30/2015	10/28/2016
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/12/2013	07/01/2013	06/30/2015	10/28/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/14/2014	01/01/2015		10/28/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/14/2014	01/01/2015	10/15/2021	10/15/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/14/2014	01/01/2015		10/28/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/14/2014	01/01/2015		10/28/2016

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH010092A	Child	DSH	DCH REGIONAL MEDICAL CENTER	Operating Room	2700 Hospital Drive	Northport	AL	Active
DSH010092B	Child	DSH	DCH REGIONAL MEDICAL CENTER	Physical Therapy	2700 Hospital Drive	Northport	AL	Active
DSH010092C	Child	DSH	DCH REGIONAL MEDICAL CENTER	Sports Medicine	1325 McFarland Blvd.	Northport	AL	Terminated
DSH010092D	Child	DSH	DCH REGIONAL MEDICAL CENTER	Neurodiagnostics	2700 Hospital Drive	Northport	AL	Active
DSH010092E	Child	DSH	DCH REGIONAL MEDICAL CENTER	Fayette Cancer Center	1653 Temple Avenue North	Fayette	AL	Active
DSH010092F	Child	DSH	DCH REGIONAL MEDICAL CENTER	Endoscopy	2700 Hospital Drive	Northport	AL	Active
DSH010092G	Child	DSH	DCH REGIONAL MEDICAL CENTER	Sleep Lab	2700 Hospital Drive	Northport	AL	Active
DSH010092H	Child	DSH	DCH REGIONAL MEDICAL CENTER	Emergency Department	2700 Hospital Drive	Northport	AL	Active
DSH010092J	Child	DSH	DCH REGIONAL MEDICAL CENTER	Diagnostic Radiology	1050 Ruby Tyler Parkway	Tuscaloosa	AL	Active
DSH010092K	Child	DSH	DCH REGIONAL MEDICAL CENTER	Cardiology	2700 Hospital Drive	Northport	AL	Active
DSH010092L	Child	DSH	DCH REGIONAL MEDICAL CENTER	Same Day Unit	2700 Hospital Drive	Northport	AL	Active
DSH010092M	Child	DSH	DCH REGIONAL MEDICAL CENTER	Anesthesia	2700 Hospital Drive	Northport	AL	Active
DSH010092N	Child	DSH	DCH REGIONAL MEDICAL CENTER	Radiology	2700 Hospital Drive	Northport	AL	Active
DSH010092P	Child	DSH	DCH REGIONAL MEDICAL CENTER	Recovery/PACU	2700 Hospital Drive	Northport	AL	Active
DSH010092Q	Child	DSH	DCH REGIONAL MEDICAL CENTER	Respiratory Therapy	2700 Hospital Drive	Northport	AL	Active
DSH010092R	Child	DSH	DCH REGIONAL MEDICAL CENTER	Spine Care	1050 Ruby Tyler parkway	Tuscaloosa	AL	Active
DSH010092S	Child	DSH	DCH REGIONAL MEDICAL CENTER	DCH Home Care Agency	1401 Greensboro Avenue	Tuscaloosa	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/8/2023 8:40:25 AM	9/9/2024 11:34:10 AM	9/9/2024 11:34 AM
Contacts	Primary Contact	Update	Profile Change Request	Thurman, Rosanne Austin Corporate Director, Pharmacy DCH 2057597944	Thurman, Rosanne Austin Corporate Director, Pharmacy DCH Regional Medical Center 2057597944	8/29/2024 9:33 AM
Contacts	Authorizing Official	Update	Change Request	DUSANG, NINA CFO DCH Regional Medical Center 2057597738	Myers, Mallary Marie COO/SVP DCH Regional Medical Center 2057597147	3/8/2024 7:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1346006483	3/7/2024 12:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	3/7/2024 12:57 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 10:08:16 AM	9/8/2023 8:40:25 AM	9/8/2023 8:40 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1073175840	6/7/2023 3:17 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	6/7/2023 3:17 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841394418	6/7/2023 3:14 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	6/7/2023 3:14 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841394418	6/7/2023 3:14 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	6/7/2023 3:14 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841394418	6/7/2023 3:14 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	6/7/2023 3:14 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841394418	6/7/2023 3:14 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	6/7/2023 3:14 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 10:14:17 AM	9/7/2022 10:08:16 AM	9/7/2022 10:08 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 7:30:48 AM	8/30/2021 10:14:17 AM	8/30/2021 10:14 AM
Medicaid Billing	NPI: State	Update	Recertification		AL	8/28/2020 7:30 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:21:02 PM	8/28/2020 7:30:48 AM	8/28/2020 7:30 AM
Addresses	Shipping Address	Insert	Change Request		DCH Regional Medical Center 809 University Blvd East Tuscaloosa, AL 35401	11/7/2019 9:06 AM
Addresses	Shipping Address	Insert	Change Request		Northport Medical Center 2700 Hospital Drive Northport, AL 35476	11/7/2019 9:06 AM
Addresses	Shipping Address	Insert	Change Request		DCH Pharmacy at DCH Medical Tower 701 University Blvd EAst M04 Tuscaloosa, AL 35401-7422	11/7/2019 9:06 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 9:10:40 AM	9/4/2019 2:21:02 PM	9/4/2019 2:21 PM
Contacts	Primary Contact	Update	Change Request	Thurman, Roseanne Director of Pharmacy DCH Regional Medical Center 2057597944	Thurman, Rosanne Austin Corporate Director, Pharmacy DCH 2057597944	6/10/2019 11:19 AM
Contacts	Primary Contact	Update	Recertification	SUTTON, BRENT PHARMACIST SPECIALIST DCH Regional Medical Center 2057597229	Thurman, Roseanne Director of Pharmacy DCH Regional Medical Center 2057597944	9/5/2018 9:10 AM
Details	Last Recertification Date	Update	Recertification	11/17/2017 3:32:18 PM	9/5/2018 9:10:40 AM	9/5/2018 9:10 AM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/17/2017 3:32:18 PM	11/17/2017 3:32 PM
Contacts	Authorizing Official	Update		DUSANG, NINA CFO 2057597738	DUSANG, NINA CFO DCH Regional Medical Center 2057597738	10/9/2017 10:48 AM
Contacts	Primary Contact	Update		SUTTON, BRENT PHARMACIST SPECIALIST 2057597229	SUTTON, BRENT PHARMACIST SPECIALIST DCH Regional Medical Center 2057597229	10/6/2017 3:10 PM
Contacts	Authorizing Official	Update		WINFREY, JOHN CFO 2057597738	DUSANG, NINA CFO 2057597738	7/17/2017 1:03 PM
Addresses	Main Address	Insert			809 UNIVERSITY BOULEVARD EAST TUSCALOOSA, AL 35401	10/28/2016 6:28 PM
Contacts	Primary Contact	Insert			SUTTON, BRENT PHARMACIST SPECIALIST 2057597229	10/28/2016 6:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Number	Insert			00020414	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: State	Insert			MS	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Number	Insert			090903300	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: State	Insert			FL	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Number	Insert			000108292A	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: State	Insert			GA	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: Number	Insert			0010092	9/15/2016 1:02 PM
Medicaid Billing	Medicaid: State	Insert			TN	9/15/2016 1:02 PM
Details	Last Recertification Date	Update		8/20/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/20/2015 1:42 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/20/2015 12:00:00 AM	8/20/2015 1:42 PM
Medicaid Billing	NPI: Number	Insert			1841394418	1/21/2015 9:16 AM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	9/5/2014 12:00:00 AM	9/5/2014 10:24 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/11/2013 12:00:00 AM	9/11/2013 12:43 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/22/2012 1:17 PM
Contacts	Authorizing Official	Insert			WINFREY, JOHN CFO 2057597738	1/3/2008 1:41 PM
Details	Last Recertification Date	Insert				1/3/2008 1:41 PM
Details	Grant Number	Insert				1/3/2008 1:41 PM
Details	340B ID	Insert			DSH010092	1/3/2008 1:41 PM
Details	Is Authorizing Official EHB Data	Insert				1/3/2008 1:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/3/2008 1:41 PM
Details	Medicare Provider Number	Insert			010092	1/3/2008 1:41 PM
Details	Entity Name	Insert			DCH REGIONAL MEDICAL CENTER	1/3/2008 1:41 PM
Details	Program Code	Insert			DSH	1/3/2008 1:41 PM
Details	Entity Subname	Insert				1/3/2008 1:41 PM
Dates	Participating Approval Date	Insert			8/23/2007 12:00:00 AM	1/3/2008 1:41 PM
Details	State	Insert			Active	1/3/2008 1:41 PM
Dates	Registration Date	Insert			8/23/2007 12:00:00 AM	1/3/2008 1:41 PM
Dates	Signed By Date	Insert				1/3/2008 1:41 PM
Dates	Start Date	Insert			1/1/2004 12:00:00 AM	1/3/2008 1:41 PM
Terminations	Termination Comments	Insert				1/3/2008 1:41 PM
Terminations	Termination Date	Insert				1/3/2008 1:41 PM
Terminations	Termination Effective Date	Insert				1/3/2008 1:41 PM
Terminations	Termination Reason	Insert				1/3/2008 1:41 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	8/23/2007 7:22 AM
Medicaid Billing	Medicaid: Number	Insert			HOS0092H	8/23/2007 7:22 AM
Medicaid Billing	Medicaid: State	Insert			AL	8/23/2007 7:22 AM