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GULF HEALTH MGMT SERVICES DBA: IH RX4U S
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
GULF HEALTH MGMT SERVICES DBA: IH RX4U S
Pharmacy Address
5 MOBILE INFIRMARY CIR
MOBILE, AL 36607-3513
Pharmacy Comments
Contract Details
Approval Date
1/5/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2023
Ownership change
Contacts
Covered Entity Signing Official
Lee Ann Cain, Vice President
(251) 279-1510
Contract Pharmacy Representative
Gulf Health MGMT
Jessica Mills, PharmD
(251) 435-4097 Ext: 2514356337
Signed By Date
1/5/2018
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