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TWIN TOWERS PHARMACY
DSH100093 BAPTIST HOSPITAL
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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
TWIN TOWERS PHARMACY
Pharmacy Address
9400 UNIVERSITY PKWY STE 118
DBA BAPTIST MEDICAL PARK PHARM
PENSACOLA, FL 32514-5752
Pharmacy Comments
Contract Details
Approval Date
3/14/2012
Contract Begin Date
3/14/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Faulkner, Administrator
(850) 469-2335
Contract Pharmacy Representative
John Porter, President
(850) 469-2335
Signed By Date
2/27/2012
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