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ALABAMA CVS PHARMACY, L.L.C.
DSH010125 LAKELAND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
LAKELAND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010125
Entity Address
42024 HIGHWAY 195 EAST
HALEYVILLE, AL 35565
Medicare Provider Number
010125
Participating Start Date
4/1/2020
Last Recertification Date
8/16/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
ALABAMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04822
1901 11TH AVENUE
HALEYVILLE, AL 35565
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
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Martha McCormick, Interim CEO
(931) 273-2720
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2018
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