Covered Entity Details

DSH010029H EAST ALABAMA MEDICAL CENTER (Terminated) - information as of 6/15/2025 6:04:19 AM

Main Details

Name

EAST ALABAMA MEDICAL CENTER

Subdivision Name

EAMC-Lanier/Radiology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010029H

Medicare Provider Number

010029

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/1/2014

Last Recertification Date

8/16/2016

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

East Alabama Medical Center
SAM PRICE, CFO
(334) 528-1313

Primary Contact

EAMC
Chuck Beams, EXECUTIVE DIRECTOR OF PHARMACY
(334) 528-3473

Addresses

Street Address

4800 48th Street
Valley, AL 36854

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	HOS0029
		1154386431

Shipping Addresses

Same as Street Address

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
DSH010029A	Child	DSH	EAST ALABAMA MEDICAL CENTER	MEDICAL ARTS DIAGNOSTICS	121 NORTH 20TH STREET, BUILDING 17	OPELIKA	AL	Terminated
DSH010029AA	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC - FREESTANDING EMERGENCY DEPT. - Free Standing ER	900 CAMP AUBURN ROAD	AUBURN	AL	Active
DSH010029AB	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC - NEUROLOGY - Neurology Clinic-Auburn	2375 CHAMPIONS BLVD	AUBURN	AL	Active
DSH010029AC	Child	DSH	EAST ALABAMA MEDICAL CENTER	Sleep Disorders Clinic of East Alabama - Sleep Center	121 N 20th St	Opelika	AL	Active
DSH010029C	Child	DSH	EAST ALABAMA MEDICAL CENTER	AUBURN DIAGNOSTIC IMAGING	900 Camp Auburn Road	AUBURN	AL	Active
DSH010029E	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier-Rehab Services	4800 48th Street	Valley	AL	Terminated
DSH010029F	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier/Laboratory	4800 48th Street	Valley	AL	Terminated
DSH010029G	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier/Operating Room	4800 48th Street	Valley	AL	Terminated
DSH010029H	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier/Radiology	4800 48th Street	Valley	AL	Terminated
DSH010029J	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier/Emergency Services	4800 48th Street	Valley	AL	Terminated
DSH010029K	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC-Lanier/Sleep Services	4800 48th Street	Valley	AL	Terminated
DSH010029L	Child	DSH	EAST ALABAMA MEDICAL CENTER	Outpatient Cardiology Non-Invasive/Auburn	2375 CHAMPIONS BLVD	AUBURN	AL	Terminated
DSH010029M	Child	DSH	EAST ALABAMA MEDICAL CENTER	East Alabama Pulmonology	2412 Village Professional Drive	Opelika	AL	Active
DSH010029N	Child	DSH	EAST ALABAMA MEDICAL CENTER	E/R PHYSICIANS - EMERGENCY	900 Camp Auburn Road	Auburn	AL	Terminated
DSH010029P	Child	DSH	EAST ALABAMA MEDICAL CENTER	INFUSION CENTER - ONCOLOGY	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029Q	Child	DSH	EAST ALABAMA MEDICAL CENTER	WOUND TREATMENT CENTER - SURGERY	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029R	Child	DSH	EAST ALABAMA MEDICAL CENTER	MEDICAL ONCOLOGY - ONCOLOGY	2501 Village Professional Drive	Opelika	AL	Active
DSH010029S	Child	DSH	EAST ALABAMA MEDICAL CENTER	SURGERY CENTER - SURGERY	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029T	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAST AL SURGICAL CLINIC - SURGERY	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029U	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAST AL INFECTIOUS DISEASE - INFECTIOUS DISEASE	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029V	Child	DSH	EAST ALABAMA MEDICAL CENTER	EMERGENCY - EMERGENCY MEDICINE	2000 Pepperell Parkway	Opelika	AL	Active
DSH010029W	Child	DSH	EAST ALABAMA MEDICAL CENTER	RADIATION THERAPY PHYSICIANS - ONCOLOGY	2501 Village Professional Drive	Opelika	AL	Active
DSH010029X	Child	DSH	EAST ALABAMA MEDICAL CENTER	ENDOCRINOLOGY AND METABOLISM OF EAS - ENDOCRINOLOGY AND METABOLISM OF EAST ALABAMA	2420 Village Professional Drive	OPELIKA	AL	Active
DSH010029Y	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC - BREAST HEALTH CENTER - Breast Health Services	900 CAMP AUBURN RD	AUBURN	AL	Active
DSH010029Z	Child	DSH	EAST ALABAMA MEDICAL CENTER	EAMC - EAH INTERNAL MEDICINE & LAB - Internal medicine residency continuity clinic	1527 PROFESSIONAL PKWY	AUBURN	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Beams, Chuck DIRECTOR OF PHARMACY EAMC 3345282473	Beams, Chuck EXECUTIVE DIRECTOR OF PHARMACY EAMC 3345283473	2/18/2021 9:42 AM
Contacts	Authorizing Official	Update		PRICE, SAM CFO 3345281313	PRICE, SAM CFO East Alabama Medical Center 3345281313	9/27/2017 2:37 PM
Contacts	Signed By	Update		PRICE, SAM CFO 3345281313	PRICE, SAM CFO East Alabama Medical Center 3345281313	9/27/2017 2:37 PM
Contacts	Primary Contact	Update		Beams, Chuck DIRECTOR OF PHARMACY 3345282473	Beams, Chuck DIRECTOR OF PHARMACY EAMC 3345282473	9/27/2017 9:33 AM
Contacts	Authorizing Official	Insert			PRICE, SAM CFO 3345281313	7/17/2017 9:25 AM
Contacts	Signed By	Insert			PRICE, SAM CFO 3345281313	7/17/2017 9:25 AM
Contacts	Primary Contact	Update		Young, Buddy Pharmacy Director 3345282473	Beams, Chuck DIRECTOR OF PHARMACY 3345282473	4/13/2017 2:20 PM
Addresses	Main Address	Insert			4800 48th Street Valley, AL 36854	9/27/2016 9:04 AM
Dates	Last Date That 340B Drugs Purchased	Update			9/30/2016 12:00:00 AM	9/27/2016 9:04 AM
Details	State	Update		Active	Terminated	9/27/2016 9:04 AM
Terminations	Termination Comments	Update			New split billing system is unable to obtain accumulations	9/27/2016 9:04 AM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	9/27/2016 9:04 AM
Terminations	Termination Effective Date	Update			10/1/2016 12:00:00 AM	9/27/2016 9:04 AM
Terminations	Termination Reason	Update			Site closure	9/27/2016 9:04 AM
Details	Last Recertification Date	Update		8/18/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/18/2015 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			HOS0029	8/18/2015 2:47 PM
Medicaid Billing	Medicaid: State	Insert			AL	8/18/2015 2:47 PM
Medicaid Billing	NPI: Number	Insert			1154386431	8/18/2015 2:47 PM
Details	Last Recertification Date	Update			8/18/2015 12:00:00 AM	8/18/2015 2:47 PM
Contacts	Primary Contact	Insert			Young, Buddy Pharmacy Director 3345282473	12/1/2014 6:09 PM
Details	Entity Subname	Update		EAMC-Lanier	EAMC-Lanier/Radiology	12/1/2014 6:08 PM
Dates	Participating Approval Date	Update			12/1/2014 12:00:00 AM	12/1/2014 6:08 PM
Details	State	Update		Pending	Active	12/1/2014 6:08 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/1/2014 6:08 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47145	DSH010029H	10/22/2014 7:35 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47145	10/13/2014 4:31 PM
Details	Last Recertification Date	Insert				10/13/2014 4:31 PM
Details	Grant Number	Insert				10/13/2014 4:31 PM
Details	340B ID	Insert				10/13/2014 4:31 PM
Details	Is Authorizing Official EHB Data	Insert				10/13/2014 4:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2014 4:31 PM
Details	Medicare Provider Number	Insert			010029	10/13/2014 4:31 PM
Details	Entity Name	Insert			EAST ALABAMA MEDICAL CENTER	10/13/2014 4:31 PM
Details	Program Code	Insert			DSH	10/13/2014 4:31 PM
Details	Entity Subname	Insert			EAMC-Lanier	10/13/2014 4:31 PM
Dates	Participating Approval Date	Insert				10/13/2014 4:31 PM
Details	State	Insert			Pending	10/13/2014 4:31 PM
Dates	Registration Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 4:31 PM
Dates	Signed By Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 4:31 PM
Dates	Start Date	Insert				10/13/2014 4:31 PM
Terminations	Termination Comments	Insert				10/13/2014 4:31 PM
Terminations	Termination Date	Insert				10/13/2014 4:31 PM
Terminations	Termination Effective Date	Insert				10/13/2014 4:31 PM
Terminations	Termination Reason	Insert				10/13/2014 4:31 PM