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ALABAMA CVS PHARMACY, L.L.C.
CAH011305-01 St. Vincent's Blount
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Covered Entity Details
Entity Name
St. Vincent's Blount
Subdivision Name
ST. VINCENT'S PRIMARY CARE - ONEONT - Primary Care Clinic
Type
Critical Access Hospital
340B ID
CAH011305-01
Entity Address
150 GILBREATH DR
ONEONTA, AL 35121-2827
Medicare Provider Number
011305
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ALABAMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04854
602 1ST AVENUE EAST
ONEONTA, AL 35121
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/12/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Gregory Dale Brown, Administrator
(205) 274-3010
Contract Pharmacy Representative
St. Vincents Blount
Gavin Keith Gilliland, Director of Pharmacy
(205) 274-3337
Signed By Date
10/13/2020
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