Contract Pharmacy Details

BOLLING PHARMACY, INC.
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

BOLLING PHARMACY, INC.

Pharmacy Address

101 TEMPLE AVE. S.
FAYETTE, AL 35555-2711

Pharmacy Comments

Contract Details

Approval Date

1/12/2012

Contract Begin Date

1/12/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/1/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Bryan N. Kindred, President/CEO
(205) 759-7329

Contract Pharmacy Representative

Trent W. Mobley, President
(205) 932-4513

Signed By Date

12/22/2011

340B Drug Pricing Program Database