Covered Entity Details

RRC010005-00 MARSHALL MEDICAL CENTER SOUTH (Terminated) - information as of 5/13/2025 1:20:20 AM

Main Details

Name

MARSHALL MEDICAL CENTER SOUTH

Subdivision Name

Type

Rural Referral Center

Rural

Yes

340B ID

RRC010005-00

Medicare Provider Number

010005

Additional Details

Current Program Status

Terminated

Registration Date

5/9/2011

Participating Start Date

7/1/2011

Participating Approval Date

5/10/2011

Last Recertification Date

8/5/2015

Termination Date
Termination Reason

4/1/2016
Change of covered entity type

Contacts

Authorizing Official

Marshall Medical Centers
GARY R. GORE, CEO
(256) 894-6611

Primary Contact

Marshall Medical Center South
KATHY B. NELSON, CFO
(256) 894-6701

Addresses

Street Address

2505 US HIGHWAY 431 NORTH
BOAZ, AL 35957

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	HOS0005H
		1306914882

Shipping Addresses

Shipping Address 1

MARSHALL CANCER CARE CENTER
11491 US HIGHWAY 431
ALBERTVILLE, AL 35950

Shipping Address 2

MARSHALL MEDICAL CENTER SOUTH
2505 US HIGHWAY 431 NORTH
BOAZ, AL 35957

Shipping Address 3

Marshall Medical Center North
8000 AL Highway 69
Guntersville, AL 35976-7140

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 # 04941	1204 N. BRINDLEE MOUNTAIN PKWY.	ARAB	AL	35016	04/15/2014	07/01/2014	04/01/2016	05/26/2016
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04968	1445 GUNTER AVENUE	GUNTERSVILLE	AL	35976	04/15/2014	07/01/2014	04/01/2016	05/26/2016
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04910	6181 US HWY 431	ALBERTVILLE	AL	35950	04/15/2014	07/01/2014	04/01/2016	05/26/2016
Contract Detail	ALBERTVILLE DISC PHARM INC	422 NORTH BROAD ST		ALBERTVILLE	AL	35950	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	BOAZ DISCOUNT DRUGS INC	10460 AL HIGHWAY 168 STE 1		BOAZ	AL	35957-1951	04/08/2014	07/01/2014	04/01/2016	05/26/2016
Contract Detail	BRINDLEY'S FAMILY PHARMACY	209 SAND MOUNTAIN DR E	SUITE 100	ALBERTVILLE	AL	35950	04/15/2015	07/01/2015	04/01/2016	05/26/2016
Contract Detail	CROSSVILLE DRUGS INC	15192 AL HIGHWAY 68		CROSSVILLE	AL	35962-3452	04/15/2015	07/01/2015	04/01/2016	05/26/2016
Contract Detail	CROWELL FAMILY PHARMACY LLC	DBA FOODLAND DISCOUNT PHARMACY	313 SAND MOUNTAIN DR E	ALBERTVILLE	AL	35950	07/07/2015	10/01/2015	04/01/2016	05/26/2016
Contract Detail	DOUGLAS DISCOUNT PHARMACY	DOUGLAS DISCOUNT PHARMACY	9461 AL HIGHWAY 75	HORTON	AL	35980	01/15/2014	04/01/2014	04/01/2016	05/26/2016
Contract Detail	GRANT PHARMACY	E.B. BARFIELD, JR	5421 MAIN ST P.O. BOX 157	GRANT	AL	35747-8322	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	LATHAM'S PHARMACY	PARRISH INC.	178 S MAIN ST	ARAB	AL	35016	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	SNEAD PHARMACY	87458 US HIGHWAY 278		SNEAD	AL	35952	04/14/2014	07/01/2014	04/01/2016	05/26/2016
Contract Detail	SORTER'S PHARMACY, INC.	DBA SORTER'S PHARMACY, INC.	8095 AL HIGHWAY 69	GUNTERSVILLE	AL	35976	04/15/2015	07/01/2015	04/01/2016	05/26/2016
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/06/2015	07/01/2015	04/01/2016	05/26/2016
Contract Detail	WAL-MART PHARMACY 10-0298	1972 HIGHWAY 431		BOAZ	AL	35957	01/08/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WAL-MART PHARMACY 10-0306	1450 N. BRINDLEE MTN PKWY		ARAB	AL	35016	01/08/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WAL-MART PHARMACY 10-0681	11697 U.S. HWY 431		GUNTERSVILLE	AL	35976	01/08/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/06/2015	07/01/2015	04/01/2016	05/26/2016
Contract Detail	WALGREEN CO	DBA: WALGREENS #10965	920 US HWY 431	BOAZ	AL	35957-1732	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WALGREEN CO	DBA: WALGREENS #11279	7155 US HIGHWAY 431	ALBERTVILLE	AL	35950-1872	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12911	1400 GUNTER AVE	GUNTERSVILLE	AL	35976	01/13/2014	04/01/2014	04/01/2016	03/24/2016
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/13/2014	04/01/2014	07/20/2015	02/18/2016
Contract Detail	WALMART PHARMACY #10-2260		87395 US HWY 278	SNEAD	AL	35952	04/06/2015	07/01/2015	01/29/2016	02/18/2016
Contract Detail	WALMART PHARMACY #10-3769		3530 CATHEDRAL CAVERNS HWY	GRANT	AL	35747	04/06/2015	07/01/2015	01/29/2016	02/18/2016

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC010005-01	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Cancer Care Center	11491 US Hwy 431	Albertville	AL	Terminated
RRC010005-02	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Professional Center - Marshall Sleep Disorders Center	11491 US Hwy 431	Albertville	AL	Terminated
RRC010005-03	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	MARSHALL MEDICAL CENTER NORTH - Marshall North - Surgery/PACU	8000 AL HIGHWAY 69	GUNTERSVILLE	AL	Terminated
RRC010005-04	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Delivery/Labor	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-05	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Anesthesia	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-06	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Radiology - MRI, Ultrasound, Xray, CT scan, Nuclear Medicine	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-07	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Lab	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-08	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Respiratory Therapy	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-09	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Cardiology - EKG, EEG, Cath Lab	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-10	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Medical Center North - Emergency Department - Emergency Department, O/P Services	8000 AL Highway 69	Guntersville	AL	Terminated
RRC010005-11	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Professional Center - Imaging Center	11491 US Hwy 431	Albertville	AL	Terminated
RRC010005-12	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Professional Center - Marshall Pain Clinic	11491 US Hwy 431	Albertville	AL	Terminated
RRC010005-13	Child	RRC	MARSHALL MEDICAL CENTER SOUTH	Marshall Professional Center - Marshall Wound Healing Center	11491 US Hwy 431	Albertville	AL	Terminated

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	GORE, GARY R. CEO 2568946611	GORE, GARY R. CEO Marshall Medical Centers 2568946611	11/14/2017 1:04 PM
Contacts	Primary Contact	Update	NELSON, KATHY B. CFO 2568946701	NELSON, KATHY B. CFO Marshall Medical Center South 2568946701	10/11/2017 4:51 PM
Contacts	Authorizing Official	Insert		GORE, GARY R. CEO 2568946611	4/19/2017 12:21 PM
Contacts	Primary Contact	Insert		NELSON, KATHY B. CFO 2568946701	8/17/2016 6:24 PM
Details	State	Update	Active	Terminated	2/18/2016 12:29 PM
Terminations	Termination Comments	Update		Registration of entity as a new entity of DSH was approved.	2/18/2016 12:29 PM
Terminations	Termination Date	Update		4/1/2016 12:00:00 AM	2/18/2016 12:29 PM
Terminations	Termination Effective Date	Update		4/1/2016 12:00:00 AM	2/18/2016 12:29 PM
Terminations	Termination Reason	Update		Change of covered entity type	2/18/2016 12:29 PM
Addresses	Main Address	Insert		2505 US HIGHWAY 431 NORTH BOAZ, AL 35957	2/18/2016 12:29 PM
Addresses	Shipping Address	Insert		MARSHALL MEDICAL CENTER SOUTH 2505 US HIGHWAY 431 NORTH BOAZ, AL 35957	2/18/2016 12:29 PM
Addresses	Shipping Address	Insert		MARSHALL CANCER CARE CENTER 11491 US HIGHWAY 431 ALBERTVILLE, AL 35950	2/18/2016 12:29 PM
Addresses	Shipping Address	Insert		Marshall Medical Center North 8000 AL Highway 69 Guntersville, AL 35976-7140	2/18/2016 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Update	True	False	8/5/2015 10:43 AM
Details	Last Recertification Date	Update	8/15/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 10:43 AM
Details	Last Recertification Date	Update	8/28/2013 12:00:00 AM	8/15/2014 12:00:00 AM	8/15/2014 1:35 PM
Details	Last Recertification Date	Update		8/28/2013 12:00:00 AM	8/28/2013 9:37 AM
Details	Last Recertification Date	Insert			5/31/2011 8:52 AM
Details	Grant Number	Insert			5/31/2011 8:52 AM
Details	340B ID	Insert		RRC010005-00	5/31/2011 8:52 AM
Details	Is Authorizing Official EHB Data	Insert			5/31/2011 8:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert			5/31/2011 8:52 AM
Details	Medicare Provider Number	Insert		010005	5/31/2011 8:52 AM
Details	Entity Name	Insert		MARSHALL MEDICAL CENTER SOUTH	5/31/2011 8:52 AM
Details	Program Code	Insert		RRC	5/31/2011 8:52 AM
Details	Entity Subname	Insert			5/31/2011 8:52 AM
Dates	Participating Approval Date	Insert		5/10/2011 12:00:00 AM	5/31/2011 8:52 AM
Details	State	Insert		Active	5/31/2011 8:52 AM
Dates	Registration Date	Insert		5/9/2011 12:00:00 AM	5/31/2011 8:52 AM
Dates	Signed By Date	Insert		5/9/2011 12:00:00 AM	5/31/2011 8:52 AM
Dates	Start Date	Insert		7/1/2011 12:00:00 AM	5/31/2011 8:52 AM
Terminations	Termination Comments	Insert			5/31/2011 8:52 AM
Terminations	Termination Date	Insert			5/31/2011 8:52 AM
Terminations	Termination Effective Date	Insert			5/31/2011 8:52 AM
Terminations	Termination Reason	Insert			5/31/2011 8:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert		True	5/9/2011 12:20 PM
Medicaid Billing	Medicaid: Number	Insert		HOS0005H	5/9/2011 12:20 PM
Medicaid Billing	Medicaid: State	Insert		AL	5/9/2011 12:20 PM
Medicaid Billing	NPI: Number	Insert		1306914882	5/9/2011 12:20 PM