Contract Pharmacy Details

ALABAMA CVS PHARMACY, L.L.C.
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

ALABAMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04372
4280 MITT LARY RD.
NORTHPORT, AL 35475

Pharmacy Comments

0322/2012 changed store # (was #35475)

Contract Details

Approval Date

3/13/2012

Contract Begin Date

3/13/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/5/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

2/8/2012

340B Drug Pricing Program Database