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WINN-DIXIE PHARMACY
DSH010078 NORTHEAST ALABAMA REGIONAL MED CTR
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Covered Entity Details
Entity Name
NORTHEAST ALABAMA REGIONAL MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010078
Entity Address
400 EAST TENTH STREET
ANNISTON, AL 36207
Medicare Provider Number
010078
Participating Start Date
1/1/2016
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WINN-DIXIE PHARMACY
Pharmacy Address
DBA WINN-DIXIE PHARMACY #447
1408 GOLDEN SPRINGS ROAD
ANNISTON, AL 36207-6924
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/26/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark North, Vice President - Finance/CFO
(256) 741-6370
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
10/15/2018
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