Contract Pharmacy Details

PUBLIX ALABAMA, LLC
DSH010092 DCH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

DCH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010092

Entity Address

809 UNIVERSITY BOULEVARD EAST
TUSCALOOSA, AL 35401

Medicare Provider Number

010092

Participating Start Date

1/1/2004

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

PUBLIX ALABAMA, LLC

Pharmacy Address

PUBLIX PHARMACY #1691
13556 HWY 69 N
NORTHPORT, AL 35475

Pharmacy Comments

Contract Details

Approval Date

4/20/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

NINA DUSANG, CFO
(205) 759-7738

Contract Pharmacy Representative

Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388

Signed By Date

4/20/2023

340B Drug Pricing Program Database