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MITCHELL CANCER INSTITUTE PHARMACY
DSH010087 USA Health University Hospital
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Covered Entity Details
Entity Name
USA Health University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010087
Entity Address
2451 University Hospital Drive
MOBILE, AL 36617
Medicare Provider Number
010087
Participating Start Date
10/1/2003
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MITCHELL CANCER INSTITUTE PHARMACY
Pharmacy Address
UNIVERSITY OF SOUTH ALABAMA MITCHELL CAN
1660 SPRING HILL AVE
STE 3069
MOBILE, AL 36604
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Traci Jones, CFO
(251) 445-9164
Contract Pharmacy Representative
USA Health Mitchell Cancer Institute Pharmacy
Theresa McLaughlin, MCI Administrator
(251) 434-3648
Signed By Date
1/15/2019
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