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ALABAMA CVS PHARMACY, L.L.C.
DSH010005 HH Health System - Marshall LLC
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Covered Entity Details
Entity Name
HH Health System - Marshall LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010005
Entity Address
2505 U.S. HIGHWAY 431
BOAZ, AL 35957
Medicare Provider Number
010005
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ALABAMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04910
6181 US HWY 431
ALBERTVILLE, AL 35950
Pharmacy Comments
Contract Details
Approval Date
3/2/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GARY R. GORE, CEO
(256) 894-6611
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
3/2/2016
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