Contract Pharmacy Details

ALABAMA CVS PHARMACY, L.L.C.
DSH010113 MOBILE INFIRMARY MEDICAL CENTER

Covered Entity Details

Entity Name

MOBILE INFIRMARY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010113

Entity Address

FIVE MOBILE INFIRMARY CIRCLE
MOBILE, AL 36607

Medicare Provider Number

010113

Participating Start Date

1/1/2018

Last Recertification Date

9/7/2023

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

ALABAMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04877
2280 DR. MARTIN LUTHER KING JR AVE
MOBILE, AL 36610

Pharmacy Comments

Contract Details

Approval Date

1/11/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lee Ann Cain, Vice President
(251) 279-1510

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/11/2016

340B Drug Pricing Program Database