Contract Pharmacy Details

WINN-DIXIE PHARMACY
DSH010029 EAST ALABAMA MEDICAL CENTER

Covered Entity Details

Entity Name

EAST ALABAMA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010029

Entity Address

2000 PEPPERELL PARKWAY
OPELIKA, AL 36801-5422

Medicare Provider Number

010029

Participating Start Date

10/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WINN-DIXIE PHARMACY

Pharmacy Address

DBA WINN-DIXIE PHARMACY #437
1441 FOXRUN PARKWAY
OPELIKA, AL 36801

Pharmacy Comments

Contract Details

Approval Date

1/8/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/20/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

SAM PRICE, CFO
(334) 528-1313

Contract Pharmacy Representative

Winn-Dixie Stores, Inc.
Gayle Shields, VP, Pharmacy
(904) 783-5000

Signed By Date

1/8/2018

340B Drug Pricing Program Database