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WALGREEN CO.
DSH010113 MOBILE INFIRMARY MEDICAL CENTER
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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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01777
3948 AIRPORT BLVD
MOBILE, AL 36608-1624
Pharmacy Comments
Contract Details
Approval Date
4/14/2016
Contract Begin Date
7/1/2016
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2016
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