Contract Pharmacy Details

ALABAMA CVS PHARMACY, L.L.C.
DSH010158 RUSSELLVILLE HOSPITAL

Covered Entity Details

Entity Name

RUSSELLVILLE HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010158

Entity Address

15155 US-43
RUSSELLVILLE, AL 35653

Medicare Provider Number

010158

Participating Start Date

4/1/2017

Last Recertification Date

8/30/2022

Entity Termination Date

10/1/2023

Pharmacy Details

Pharmacy Name

ALABAMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00078
14695 HWY 43
RUSSELLVILLE, AL 35653

Pharmacy Comments

Contract Details

Approval Date

7/16/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Tim Brown, Chief Financial Officer
(865) 888-9359

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/16/2018

340B Drug Pricing Program Database