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ALABAMA CVS PHARMACY, L.L.C.
RRC010005-00 MARSHALL MEDICAL CENTER SOUTH
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Covered Entity Details
Entity Name
MARSHALL MEDICAL CENTER SOUTH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010005-00
Entity Address
2505 US HIGHWAY 431 NORTH
BOAZ, AL 35957
Medicare Provider Number
010005
Participating Start Date
7/1/2011
Last Recertification Date
8/5/2015
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
ALABAMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04968
1445 GUNTER AVENUE
GUNTERSVILLE, AL 35976
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
GARY R. GORE, CEO
(256) 894-6611
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/15/2014
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