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PUBLIX ALABAMA, LLC
RRC010039-00 HUNTSVILLE HOSPITAL
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Covered Entity Details
Entity Name
HUNTSVILLE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010039-00
Entity Address
101 SIVLEY ROAD SW
HUNTSVILLE, AL 35801
Medicare Provider Number
010039
Participating Start Date
12/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PUBLIX ALABAMA, LLC
Pharmacy Address
PUBLIX PHARMACY #1609
2934 POINT MALLARD PKWY, SE
DECATUR, AL 35603
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
1/18/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clinton Carter, CFO
(256) 265-8818
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
1/11/2022
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