340B Drug Pricing Program Database
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RRC010113-03 MOBILE INFIRMARY MEDICAL CENTER (Active)
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Main Details
Name
MOBILE INFIRMARY MEDICAL CENTER
Subdivision Name
INFIRMARY 65 DIAGNOSTIC CENTER - PET/CT
Type
Rural Referral Center
Rural
No
340B ID
RRC010113-03
Medicare Provider Number
010113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/18/2024
Last Recertification Date
Contacts
Authorizing Official
Mobile Infirmary
Lee Ann Cain, Vice President
(251) 279-1510
Primary Contact
Mobile Infirmary
Michelle Wheat, 340B Coordinator
(251) 435-2683
Addresses
Street Address
3290 DAUPHIN ST
MOBILE, AL 36606-4062
Billing Address
Mobile Infirmary Medical Center
PO Box 2144
Mobile, AL 36652
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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