Covered Entity Details

DSH010129C GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY (Active) - information as of 5/10/2025 11:17:14 PM

Main Details

Name

GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY

Subdivision Name

Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Mobile - Infusion

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010129C

Medicare Provider Number

010129

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/25/2018

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

North Baldwin Infirmary
Kenny H Breal, President
(251) 648-7673

Primary Contact

Mobile Infirmary
Michelle Wheat, 340B Coordinator
(251) 435-2683

Addresses

Street Address

3 Mobile Infirmary Circle, Suite 301
Mobile, AL 36607-3515

Billing Address

Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary
1815 Hand Ave
Bay Minette, AL 36507

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	20333	1134164924
FL	3308400	1134164924
AL	HOS0129H	1134164924

Shipping Addresses

Shipping Address 1

Mobile Infirmary Medical Center
5 Mobile Infirmary Circle
Mobile, AL 36607

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
DSH010129B	Child	DSH	GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center - Mobile Infusion	3 Mobile Infirmary Circle	Mobile	AL	Terminated
DSH010129C	Child	DSH	GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Mobile - Infusion	3 Mobile Infirmary Circle, Suite 301	Mobile	AL	Active
DSH010129D	Child	DSH	GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY	Outpatient Infusion Services-Malbis - Infusion	9570 US Highway 90	Daphne	AL	Active
DSH010129E	Child	DSH	GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY	Infusion and Oncology Services Saraland - infusion	95 Shell Street, Suite 300	Saraland	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	188 Hospital Drive Medical Office Complex Fairhope, AL 36532	3 Mobile Infirmary Circle, Suite 301 Mobile, AL 36607-3515	9/19/2024 6:54 AM
Addresses	Shipping Address	Update	Change Request	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary 1815 Hand Ave Bay Minette, AL 36507	Mobile Infirmary Medical Center 5 Mobile Infirmary Circle Mobile, AL 36607	9/19/2024 6:54 AM
Details	Entity Subname	Update	Change Request	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Fairhope - Infusion	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Mobile - Infusion	9/19/2024 6:54 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 1:49:46 PM	8/12/2024 2:25:37 PM	8/12/2024 2:25 PM
Contacts	Primary Contact	Update	Profile Change Request	Wheat, Michelle Pharmacist Informatics Coordinator Mobile Infirmary 2514352683	Wheat, Michelle 340B Coordinator Mobile Infirmary 2514352683	7/29/2024 1:27 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 11:22:05 AM	8/16/2023 1:49:46 PM	8/16/2023 1:49 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 2:58:42 PM	9/14/2022 11:22:05 AM	9/14/2022 11:22 AM
Contacts	Authorizing Official	Update	Change Request	Hansert, Ben ADMINISTRATOR Gulf Health Hospitals dba North Baldwin Infirmary 2519375521-41717	Breal, Kenny H President North Baldwin Infirmary 2516487673	8/12/2022 1:44 PM
Contacts	Primary Contact	Update	Group Change Request	Knight, Kellye Pharmacy Manager Gulf Health Hospital, dba North Baldwin Infirmary 2515801718	Wheat, Michelle Pharmacist Informatics Coordinator Mobile Infirmary 2514352683	3/18/2022 10:29 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 1:08:32 PM	8/24/2021 2:58:42 PM	8/24/2021 2:58 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134164924	9/8/2020 1:08 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/8/2020 1:08 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134164924	9/8/2020 1:08 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/8/2020 1:08 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134164924	9/8/2020 1:08 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/8/2020 1:08 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1134164924 ( )		9/8/2020 1:08 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 12:04:53 PM	9/8/2020 1:08:32 PM	9/8/2020 1:08 PM
Details	Last Recertification Date	Update	Recertification	8/27/2018 12:12:02 PM	9/10/2019 12:04:53 PM	9/10/2019 12:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 9:08 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		20333	1/18/2019 9:08 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	1/18/2019 9:08 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2019 9:08 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3308400	1/18/2019 9:08 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	1/18/2019 9:08 AM
Details	Last Recertification Date	Update	Recertification		8/27/2018 12:12:02 PM	8/27/2018 12:12 PM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Hansert, Ben ADMINISTRATOR Gulf Health Hospitals dba North Baldwin Infirmary 2519375521-41717	1/25/2018 7:22 AM
Details	340B ID	Update	New Registration		DSH010129C	1/25/2018 7:22 AM
Details	Entity Subname	Update	New Registration	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Fairhope	Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Fairhope - Infusion	1/25/2018 7:22 AM
Dates	Participating Approval Date	Update	New Registration		1/25/2018 7:22:19 AM	1/25/2018 7:22 AM
Details	State	Update	New Registration	Pending	Approved	1/25/2018 7:22 AM
Dates	Signed By Date	Update	New Registration		1/12/2018 12:16:19 PM	1/25/2018 7:22 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/25/2018 7:22 AM
Addresses	Main Address	Insert	New Registration		188 Hospital Drive Medical Office Complex Fairhope, AL 36532	1/12/2018 12:16 PM
Addresses	Billing Address	Insert	New Registration		Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary 1815 Hand Ave Bay Minette, AL 36507	1/12/2018 12:16 PM
Addresses	Shipping Address	Insert	New Registration		Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary 1815 Hand Ave Bay Minette, AL 36507	1/12/2018 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2018 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS0129H	1/12/2018 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	1/12/2018 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1134164924	1/12/2018 12:16 PM
Contacts	Primary Contact	Insert	New Registration		Knight, Kellye Pharmacy Manager Gulf Health Hospital, dba North Baldwin Infirmary 2515801718	1/12/2018 12:16 PM
Contacts	Authorizing Official	Insert	New Registration		Hansert, Ben ADMINISTRATOR Gulf Health Hospitals dba North Baldwin Infirmary 2519375521-41717	1/12/2018 12:16 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2018 12:16 PM
Details	Grant Number	Insert	New Registration			1/12/2018 12:16 PM
Details	340B ID	Insert	New Registration			1/12/2018 12:16 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2018 12:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2018 12:16 PM
Details	Medicare Provider Number	Insert	New Registration		010129	1/12/2018 12:16 PM
Details	Entity Name	Insert	New Registration		GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY	1/12/2018 12:16 PM
Details	Program Code	Insert	New Registration		DSH	1/12/2018 12:16 PM
Details	Entity Subname	Insert	New Registration		Gulf Health Hospitals, Inc. DBA North Baldwin Infirmary Infusion Center-Fairhope	1/12/2018 12:16 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2018 12:16 PM
Details	State	Insert	New Registration		Pending	1/12/2018 12:16 PM
Dates	Registration Date	Insert	New Registration		1/12/2018 12:16:17 PM	1/12/2018 12:16 PM
Dates	Signed By Date	Insert	New Registration			1/12/2018 12:16 PM
Dates	Start Date	Insert	New Registration			1/12/2018 12:16 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2018 12:16 PM
Terminations	Termination Date	Insert	New Registration			1/12/2018 12:16 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2018 12:16 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2018 12:16 PM