Contract Pharmacy Details

BAPTIST HOSPITAL INC
DSH100093 BAPTIST HOSPITAL

Covered Entity Details

Entity Name

BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100093

Entity Address

123 Baptist Way
PENSACOLA, FL 32503

Medicare Provider Number

100093

Participating Start Date

4/1/2009

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

BAPTIST HOSPITAL INC

Pharmacy Address

1110 GULF BREEZE PARKWAY
GULF BREEZE, FL 32561

Pharmacy Comments

Contract Details

Approval Date

8/9/2011

Contract Begin Date

8/9/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Wildebrandt, Administrator
(850) 469-2319

Contract Pharmacy Representative

Bob Harriman, Administrator
(850) 934-2100

Signed By Date

7/26/2011