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WAL-MART PHARMACY 10-0425
DSH010058 BIBB MEDICAL CENTER
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Covered Entity Details
Entity Name
BIBB MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010058
Entity Address
208 PIERSON AVENUE
CENTREVILLE, AL 35042
Medicare Provider Number
010058
Participating Start Date
7/1/2017
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0425
Pharmacy Address
10675 HIGHWAY 5
BRENT, AL 35034
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Marchant, CEO
(205) 926-3361
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/8/2019
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