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PUBLIX ALABAMA, LLC
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
PUBLIX ALABAMA, LLC
Pharmacy Address
PUBLIX PHARMACY #1420
115 COMMONS WAY
OXFORD, AL 36203
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark North, Vice President - Finance/CFO
(256) 741-6370
Contract Pharmacy Representative
Publix
Kimberly Bone, Manager of Managed Care, Pharmacy Operations
(863) 688-1188 Ext: 52364
Signed By Date
10/15/2018
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