Covered Entity Details

DSH010058 BIBB MEDICAL CENTER (Active) - information as of 6/19/2025 11:51:11 PM

Main Details

Name

BIBB MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010058

Medicare Provider Number

010058

Additional Details

Current Program Status

Active

Registration Date

4/3/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/7/2017

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Bibb Medical Center
Joseph Marchant, CEO
(205) 926-3361

Primary Contact

Bibb Medical Center
Heather Desmond, CFO
(205) 926-3281

Addresses

Street Address

208 PIERSON AVENUE
CENTREVILLE, AL 35042

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	100010134,540003976,HOS0058H	1568558146,1255376828,1972532299,1104530963

Shipping Addresses

Shipping Address 1

Bibb Medical Center
208 Pierson Ave
Centreville, AL 35042

Shipping Address 2

Bibb Medical Center Hospital and Nursing Home
165 Pierson Ave
Centreville, AL 35042

Shipping Address 3

Bibb Co Hospital & Nursing Home
208 Pierson Ave
Centreville, AL 35042

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04897	155 BIRMINGHAM ROAD SUITE 114	CENTREVILLE	AL	35042	04/14/2020	07/01/2020		07/01/2020
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04835	1910 MCFARLAND BOULEVARD	NORTHPORT	AL	35476	10/14/2020	01/01/2021		01/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02505	93 EUCLID AVENUE	MOUNTAIN BRK	AL	35213	10/14/2020	01/01/2021		01/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04813	4260 UNIVERSITY BLVD EAST	TUSCALOOSA	AL	35404	10/14/2020	01/01/2021		01/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04969	536 HUDSON DR., PO BOX 653	GORDO	AL	35466	10/14/2020	01/01/2021		01/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04819	808 VETERANS MEMORIAL PKWY	TUSCALOOSA	AL	35404	04/12/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07112	700 MAIN ST.	MONTEVALLO	AL	35115	04/12/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17547	5561 GROVE BLVD	BIRMINGHAM	AL	35226	10/13/2021	01/01/2022		01/01/2022
Contract Detail	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09273	3785 WEST INA RD.	TUCSON	AZ	85741	01/13/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/10/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/12/2021	07/01/2021	01/01/2024	01/26/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/10/2023	07/01/2023		07/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/15/2024	07/01/2024	10/31/2024	04/04/2025
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/15/2024	07/01/2024	10/31/2024	04/04/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/15/2024	07/01/2024	10/31/2024	04/04/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/15/2024	07/01/2024	10/31/2024	04/04/2025
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03991	1525 BUFORD DR	LAWRENCEVILLE	GA	30043	10/13/2021	01/01/2022		01/01/2022
Contract Detail	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	10/14/2020	01/01/2021	05/11/2023	07/13/2023
Contract Detail	J & S DRUGS INC	1130 WALNUT ST		CENTREVILLE	AL	35042	04/14/2020	07/01/2020		07/01/2020
Contract Detail	JACK'S DISCOUNT PHARMACY	JACK'S DISCOUNT PHARMACY	23010 HIGHWAY 5 PO BOX 680	WEST BLOCTON	AL	35184-3522	04/12/2021	07/01/2021	01/31/2025	04/04/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/10/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/10/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/10/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/10/2023	07/01/2023		07/01/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/16/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-0425	10675 HIGHWAY 5		BRENT	AL	35034	07/08/2019	10/01/2019		10/01/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/16/2019	01/01/2020		01/01/2020
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/10/2023	07/01/2023		07/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/15/2025 5:22 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		540003976	4/15/2025 5:22 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	4/15/2025 5:22 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1972532299	4/15/2025 5:22 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	4/15/2025 5:22 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1104530963	4/15/2025 5:22 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	4/15/2025 5:22 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:45:42 AM	8/14/2024 2:30:45 PM	8/14/2024 2:30 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 6:26:01 AM	8/21/2023 11:45:42 AM	8/21/2023 11:45 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 12:10:15 PM	8/30/2022 6:26:01 AM	8/30/2022 6:26 AM
Details	Last Recertification Date	Update	Recertification	8/24/2020 10:52:19 AM	8/27/2021 12:10:15 PM	8/27/2021 12:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/14/2020 3:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100010134	10/14/2020 3:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	10/14/2020 3:04 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1568558146	10/14/2020 3:04 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	10/14/2020 3:04 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255376828	10/14/2020 3:04 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	10/14/2020 3:04 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 11:56:26 AM	8/24/2020 10:52:19 AM	8/24/2020 10:52 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 5:58:36 PM	8/20/2019 11:56:26 AM	8/20/2019 11:56 AM
Details	Last Recertification Date	Update	Recertification	12/4/2017 5:37:58 PM	8/21/2018 5:58:36 PM	8/21/2018 5:58 PM
Addresses	Shipping Address	Insert	Change Request		Bibb Co Hospital & Nursing Home 208 Pierson Ave Centreville, AL 35042	6/19/2018 12:39 PM
Addresses	Shipping Address	Insert	Recertification		Bibb Medical Center 208 Pierson Ave Centreville, AL 35042	12/4/2017 5:37 PM
Addresses	Shipping Address	Insert	Recertification		Bibb Medical Center Hospital and Nursing Home 165 Pierson Ave Centreville, AL 35042	12/4/2017 5:37 PM
Details	Last Recertification Date	Update	Recertification		12/4/2017 5:37:58 PM	12/4/2017 5:37 PM
Contacts	Authorizing Official	Update		Marchant, Joseph CEO 2059263361	Marchant, Joseph CEO Bibb Medical Center 2059263361	11/21/2017 4:53 PM
Contacts	Signed By	Update		Marchant, Joseph CEO 2059263361	Marchant, Joseph CEO Bibb Medical Center 2059263361	11/21/2017 4:53 PM
Contacts	Primary Contact	Update		Desmond, Heather CFO 2059263281	Desmond, Heather CFO Bibb Medical Center 2059263281	11/1/2017 12:04 PM
Addresses	Main Address	Insert			208 PIERSON AVENUE CENTREVILLE, AL 35042	7/20/2017 9:19 AM
Contacts	Primary Contact	Insert			Desmond, Heather CFO 2059263281	7/20/2017 9:19 AM
Contacts	Authorizing Official	Insert			Marchant, Joseph CEO 2059263361	7/20/2017 9:19 AM
Contacts	Signed By	Insert			Marchant, Joseph CEO 2059263361	7/20/2017 9:19 AM
Dates	Participating Approval Date	Update			4/7/2017 12:00:00 AM	4/7/2017 1:43 PM
Details	State	Update		Pending	Active	4/7/2017 1:43 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/7/2017 1:43 PM
Details	340B ID	Update		ONLINE_REG_75724	DSH010058	4/3/2017 1:31 PM
Details	340B ID	Update			ONLINE_REG_75724	4/3/2017 9:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2017 9:56 AM
Medicaid Billing	Medicaid: Number	Insert			HOS0058H	4/3/2017 9:56 AM
Medicaid Billing	Medicaid: State	Insert			AL	4/3/2017 9:56 AM
Details	Last Recertification Date	Insert				4/3/2017 9:56 AM
Details	Grant Number	Insert				4/3/2017 9:56 AM
Details	340B ID	Insert				4/3/2017 9:56 AM
Details	Is Authorizing Official EHB Data	Insert				4/3/2017 9:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2017 9:56 AM
Details	Medicare Provider Number	Insert			010058	4/3/2017 9:56 AM
Details	Entity Name	Insert			BIBB MEDICAL CENTER	4/3/2017 9:56 AM
Details	Program Code	Insert			DSH	4/3/2017 9:56 AM
Details	Entity Subname	Insert				4/3/2017 9:56 AM
Dates	Participating Approval Date	Insert				4/3/2017 9:56 AM
Details	State	Insert			Pending	4/3/2017 9:56 AM
Dates	Registration Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 9:56 AM
Dates	Signed By Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 9:56 AM
Dates	Start Date	Insert				4/3/2017 9:56 AM
Terminations	Termination Comments	Insert				4/3/2017 9:56 AM
Terminations	Termination Date	Insert				4/3/2017 9:56 AM
Terminations	Termination Effective Date	Insert				4/3/2017 9:56 AM
Terminations	Termination Reason	Insert				4/3/2017 9:56 AM