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WAL-MART PHARMACY 10-0715
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
WAL-MART PHARMACY 10-0715
Pharmacy Address
1501 SKYLAND BLVD EAST
TUSCALOOSA, AL 35405
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/21/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
NINA DUSANG, CFO
(205) 759-7738
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2015
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