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EAST ALABAMA APOTHECARY STORE 3
DSH010120 MONROE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
MONROE COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010120
Entity Address
2016 S Alabama Ave
MONROEVILLE, AL 36460
Medicare Provider Number
010120
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
EAST ALABAMA APOTHECARY STORE 3
Pharmacy Address
1171 GATEWOOD DR STE 1200
AUBURN, AL 36830
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Cynthia Martens, Director of Pharmacy
(251) 743-7434
Contract Pharmacy Representative
EAMC
Trey Bankson, 340B contact
(334) 528-3950
Signed By Date
7/11/2019
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