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GUEST APOTHECARY INC
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
GUEST APOTHECARY INC
Pharmacy Address
DBA PHYSICIANS APOTHECARY
102A EBLE ST
GADSDEN, AL 35904-3933
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
7/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark North, Vice President - Finance/CFO
(256) 741-6370
Contract Pharmacy Representative
Physicians Apothecary
Danny Guest, Pharmacist
(256) 547-8631
Signed By Date
10/15/2018
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