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RX4U AT MALBIS
DSH010129 GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY
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Covered Entity Details
Entity Name
GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010129
Entity Address
1815 HAND AVE.
BAY MINETTE, AL 36507
Medicare Provider Number
010129
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
RX4U AT MALBIS
Pharmacy Address
29487 STATE HIGHWAY 181
DAPHNE, AL 36526
Pharmacy Comments
Contract Details
Approval Date
1/6/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2023
Ownership change
Contacts
Covered Entity Signing Official
Ben Hansert, ADMINISTRATOR
(251) 937-5521 Ext: 41717
Contract Pharmacy Representative
Gulf Health Management Services
Sim Sokom, Pharmacist in Charge
(251) 279-5455
Signed By Date
1/6/2020
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