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CORAM HEALTHCARE CORPORATION OF ALABAMA
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
CORAM HEALTHCARE CORPORATION OF ALABAMA
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
300 RIVERHILLS BUS PARK
SUITE 390
BIRMINGHAM, AL 35242-8101
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/6/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew L. Terry, Vice President Revenue Management
(850) 469-7643
Contract Pharmacy Representative
Beverly Thomas, Director
(205) 995-8117
Signed By Date
7/17/2017
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