Contract Pharmacy Details

ALABAMA CVS PHARMACY, L.L.C.
DSH010129 GULF HEALTH HOSPITALS, INC. DBA NORTH BALDWIN INFIRMARY

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

ALABAMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04938
208 MCMEANS AVE.
BAY MINETTE, AL 36507

Pharmacy Comments

Contract Details

Approval Date

7/8/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/1/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ben Hansert, ADMINISTRATOR
(251) 937-5521 Ext: 41717

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/8/2016

340B Drug Pricing Program Database