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ALABAMA CVS PHARMACY, L.L.C.
DSH010092 DCH REGIONAL MEDICAL CENTER
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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 # 07217
4715 RICE MINE RD. NE
TUSCALOOSA, AL 35406
Pharmacy Comments
Contract Details
Approval Date
7/1/2013
Contract Begin Date
10/1/2013
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
NINA DUSANG, CFO
(205) 759-7738
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
7/1/2013
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