Covered Entity Details

DSH010087B USA Health University Hospital (Active) - information as of 5/14/2025 10:47:04 PM

Main Details

Name

USA Health University Hospital

Subdivision Name

INFUSION CLINIC AT MCI FAIRHOPE

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010087B

Medicare Provider Number

010087

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

6/10/2009

Participating Start Date

7/1/2009

Participating Approval Date

6/14/2009

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

USA Health Systems
Kristen Roberts, Chief Financial Officer
(251) 460-6241

Primary Contact

University of South Alabama Health System
Davin Patel, Pharmacy Compliance Manager
(251) 214-5465

Addresses

Street Address

2451 University Hospital Drive
Mobile, AL 36617

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
AL	HOS0087H	1063468072

Shipping Addresses

Shipping Address 1

USA Infusion Clinic At MCI Fairhope
1047 Fairhope Ave
Pharmacy Dept
Fairhope, AL 36532

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH010087A	Child	DSH	USA Health University Hospital	INFUSION CLINIC AT MCI MOBILE	2451 University Hospital Drive	MOBILE	AL	Terminated
DSH010087B	Child	DSH	USA Health University Hospital	INFUSION CLINIC AT MCI FAIRHOPE	2451 University Hospital Drive	Mobile	AL	Active
DSH010087C	Child	DSH	USA Health University Hospital	Cyberknife Therapeutic Radiology Clinic	2451 University Hospital Drive	Mobile	AL	Active
DSH010087D	Child	DSH	USA Health University Hospital	Infusion at University Commons - Infusion	2451 University Hospital Drive	Mobile	AL	Active
DSH010087E	Child	DSH	USA Health University Hospital	Infusion Clinc at Springhill - Infusion	2451 University Hospital Drive	Mobile	AL	Active
DSH010087F	Child	DSH	USA Health University Hospital	Internal Medicine - UH IM Nepherology PBB	2451 University Hospital Drive	Mobile	AL	Active
DSH010087G	Child	DSH	USA Health University Hospital	Internal Medicine - Internal Medicine Pulmonary UH	2451 University Hospital Drive	Mobile	AL	Active
DSH010087H	Child	DSH	USA Health University Hospital	Internal Medicine - UH IM Infectious Disease PBB	2451 University Hospital Drive	Mobile	AL	Active
DSH010087J	Child	DSH	USA Health University Hospital	Internal Medicine - UH IM General PBB	2451 University Hospital Dr/Mastin Profession Building	Mobile	AL	Active
DSH010087K	Child	DSH	USA Health University Hospital	Digestive Health Center - UH IM Gastroenterology PBB	75 South University Blvd	Mobile	AL	Active
DSH010087L	Child	DSH	USA Health University Hospital	MCI-BRONCHOSCOPY - MCI-BRONCH LAB	1660 Springhill Avenue	Mobile	AL	Active
DSH010087M	Child	DSH	USA Health University Hospital	USA Health Freestanding Emergency Department - Freestanding Emergency Department	181 Hillcrest Road	Mobile	AL	Active
DSH010087N	Child	DSH	USA Health University Hospital	Infusion Clinic at Providence - Infusion - Infusion	6701 Airport Boulevard, Building B	mobile	AL	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Stover, Benny J USA Health, CFO USA Health University Hospital 2514459164	Roberts, Kristen Chief Financial Officer USA Health Systems 2514606241	3/24/2025 6:50 AM
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:55:42 AM	8/20/2024 9:05:12 AM	8/20/2024 9:05 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 2:45:09 PM	8/15/2023 8:55:42 AM	8/15/2023 8:55 AM
Contacts	Primary Contact	Update	Change Request	Weaver, Rachel M Clinical Pharmacist USA Health University Hospital 2514717388	Patel, Davin Pharmacy Compliance Manager University of South Alabama Health System 2512145465	8/26/2022 6:52 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 3:40:22 PM	8/25/2022 2:45:09 PM	8/25/2022 2:45 PM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:20:42 AM	8/31/2021 3:40:22 PM	8/31/2021 3:40 PM
Contacts	Authorizing Official	Update	Change Request	Jones, Traci CFO University of South Alabama 2514459164	Stover, Benny J USA Health, CFO USA Health University Hospital 2514459164	11/18/2020 1:58 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1063468072	8/17/2020 11:20 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	8/17/2020 11:20 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1063468072 ( )		8/17/2020 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 9:12:49 AM	8/17/2020 11:20:42 AM	8/17/2020 11:20 AM
Addresses	Main Address	Update	Change Request	2451 Fillingim Street Mobile, AL 36617	2451 University Hospital Drive Mobile, AL 36617	9/18/2019 7:44 AM
Details	Last Recertification Date	Update	Recertification	8/15/2018 11:18:36 AM	8/20/2019 9:12:49 AM	8/20/2019 9:12 AM
Contacts	Primary Contact	Update	Change Request	Bethea, Steve Chief Pharmacist University of South Alabama Medical Center 2514717390	Weaver, Rachel M Clinical Pharmacist USA Health University Hospital 2514717388	4/10/2019 11:08 AM
Details	Entity Name	Update	Change Request	UNIVERSITY OF SOUTH ALABAMA MEDICAL CTR	USA Health University Hospital	11/26/2018 10:16 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 5:14:45 PM	8/15/2018 11:18:36 AM	8/15/2018 11:18 AM
Details	Last Recertification Date	Update	Recertification	10/24/2017 1:16:24 PM	11/6/2017 5:14:45 PM	11/6/2017 5:14 PM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	10/24/2017 1:16:24 PM	10/24/2017 1:16 PM
Addresses	Shipping Address	Insert	Change Request		USA Infusion Clinic At MCI Fairhope 1047 Fairhope Ave Pharmacy Dept Fairhope, AL 36532	10/2/2017 7:12 AM
Contacts	Authorizing Official	Update		Jones, Traci CFO 2514459164	Jones, Traci CFO University of South Alabama 2514459164	9/29/2017 10:17 AM
Contacts	Primary Contact	Update		Bethea, Steve Chief Pharmacist 2514717390	Bethea, Steve Chief Pharmacist University of South Alabama Medical Center 2514717390	9/27/2017 4:38 PM
Contacts	Primary Contact	Insert			Bethea, Steve Chief Pharmacist 2514717390	2/22/2017 8:00 AM
Contacts	Authorizing Official	Update		Anderson, Anna Elizabeth Hospital Administrator 2514717110	Jones, Traci CFO 2514459164	2/22/2017 8:00 AM
Addresses	Shipping Address	Delete		USA Infusion Clinic At MCI Fairhope 188 Hospital Drive Suite 400 Fairhope, AL 36532		2/22/2017 8:00 AM
Addresses	Main Address	Insert			2451 Fillingim Street Mobile, AL 36617	2/22/2017 8:00 AM
Addresses	Shipping Address	Insert			USA Infusion Clinic At MCI Fairhope 188 Hospital Drive Suite 400 Fairhope, AL 36532	2/22/2017 8:00 AM
Contacts	Authorizing Official	Insert			Anderson, Anna Elizabeth Hospital Administrator 2514717110	8/19/2016 4:23 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/19/2016 4:19 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 1:58 PM
Medicaid Billing	Medicaid: Number	Update		H0S0087H	HOS0087H	2/13/2015 1:10 PM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	9/5/2014 12:00:00 AM	9/5/2014 10:23 AM
Details	Last Recertification Date	Update		9/5/2013 6:32:13 AM	9/5/2013 12:00:00 AM	1/3/2014 7:16 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 6:32:13 AM	9/5/2013 6:32 AM
Details	Entity Subname	Update		USA MITCHELL CANCER INSTITUTE - FAIRHOPE	INFUSION CLINIC AT MCI FAIRHOPE	4/2/2013 3:42 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	5/14/2012 7:32 AM
Medicaid Billing	Medicaid: Number	Update		H080087H	H0S0087H	5/14/2012 7:32 AM
Medicaid Billing	NPI: Number	Insert			1063468072	5/14/2012 7:32 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 7:32 AM
Details	Last Recertification Date	Insert				6/14/2009 11:21 PM
Details	Grant Number	Insert				6/14/2009 11:21 PM
Details	340B ID	Insert			DSH010087B	6/14/2009 11:21 PM
Details	Is Authorizing Official EHB Data	Insert				6/14/2009 11:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/14/2009 11:21 PM
Details	Medicare Provider Number	Insert			010087	6/14/2009 11:21 PM
Details	Entity Name	Insert			UNIVERSITY OF SOUTH ALABAMA MEDICAL CTR	6/14/2009 11:21 PM
Details	Program Code	Insert			DSH	6/14/2009 11:21 PM
Details	Entity Subname	Insert			USA MITCHELL CANCER INSTITUTE - FAIRHOPE	6/14/2009 11:21 PM
Dates	Participating Approval Date	Insert			6/14/2009 12:00:00 AM	6/14/2009 11:21 PM
Details	State	Insert			Active	6/14/2009 11:21 PM
Dates	Registration Date	Insert			6/10/2009 12:00:00 AM	6/14/2009 11:21 PM
Dates	Signed By Date	Insert			3/3/2009 12:00:00 AM	6/14/2009 11:21 PM
Dates	Start Date	Insert			7/1/2009 12:00:00 AM	6/14/2009 11:21 PM
Terminations	Termination Comments	Insert				6/14/2009 11:21 PM
Terminations	Termination Date	Insert				6/14/2009 11:21 PM
Terminations	Termination Effective Date	Insert				6/14/2009 11:21 PM
Terminations	Termination Reason	Insert				6/14/2009 11:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	6/10/2009 12:13 PM
Medicaid Billing	Medicaid: Number	Insert			H080087H	6/10/2009 12:13 PM
Medicaid Billing	Medicaid: State	Insert			AL	6/10/2009 12:13 PM