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EXPRESS SCRIPTS PHARMACY, INC.
DSH010058 BIBB MEDICAL CENTER
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Covered Entity Details
Entity Name
BIBB MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010058
Entity Address
208 PIERSON AVENUE
CENTREVILLE, AL 35042
Medicare Provider Number
010058
Participating Start Date
7/1/2017
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joseph Marchant, CEO
(205) 926-3361
Contract Pharmacy Representative
Bibb Medical Center Pharmacy
Jennifer Guthrie, Pharmacy Director
(205) 926-3277
Signed By Date
4/15/2024
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