Covered Entity Details

CH044700 Bayou La Batre Area Health Development Board, Inc (Active) - information as of 6/7/2025 6:08:49 AM

Main Details

Name

Bayou La Batre Area Health Development Board, Inc

Subdivision Name

MOSTELLAR MEDICAL CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004489

340B ID

CH044700

Grant Number

H80CS00098

Additional Details

Current Program Status

Active

Registration Date

7/1/2001

Participating Start Date

7/1/2001

Participating Approval Date

7/1/2001

Last Recertification Date

2/20/2025

Contacts

Authorizing Official

Bayou La Batre Area Health Development Board, Inc.
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229

Primary Contact

Bayou La Batre Area Health Development Board Inc.
Todd Stork, COO
(251) 824-2174 Ext: 5275

Addresses

Street Address

12701 PADGETT SWITCH ROAD
IRVINGTON, AL 36544-4011

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
11/12/14 corrected site ID to the EHB record for the service delivery site (from the Admin-only EHB site) and updated the corresponding address fields	11/12/2014

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06017	12900 N. WINTZELL AVE.	BAYOU LA BATRE	AL	36509	10/04/2016	01/01/2017		10/04/2016
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04782	10115 GRAND BAY WILMER RD. SOUTH	GRAND BAY	AL	36541	01/09/2018	04/01/2018		01/09/2018
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04877	2280 DR. MARTIN LUTHER KING JR AVE	MOBILE	AL	36610	10/04/2021	01/01/2022		01/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04883	9151 MOFFETT RD	SEMMES	AL	36575	10/04/2021	01/01/2022		01/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07671	1401 HILLCREST RD	MOBILE	AL	36695-4032	10/04/2021	01/01/2022		01/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02567	7081 AIRPORT RD	MOBILE	AL	36608	10/04/2021	01/01/2022		01/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10181	5400 HWY 280	HOOVER	AL	35242	10/04/2021	01/01/2022		01/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02675	900 GOVERNMENT ST.	MOBILE	AL	36604	10/04/2021	01/01/2022	11/30/2022	12/27/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04818	4881 SCHILLINGER RD. S	MOBILE	AL	36619	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07668	19215 NORTH 3RD ST.	CITRONELLE	AL	36522	07/10/2024	10/01/2024		10/01/2024
Contract Detail	B & F DRUGS		16900 JORDAN STREET PO BOX 807	CHATOM	AL	36518	01/15/2015	04/01/2015		01/15/2015
Contract Detail	BAYOU PHARMACY LLC DBA BAYOU PHARMACY	12855 PADGETT SWITCH RD		IRVINGTON	AL	36544-4015	01/17/2014	04/01/2014		01/17/2014
Contract Detail	CARECENTER PHARMACY, L.L.C.	CAREPLUS CVS/PHARMACY #10923	2105 OLD SPANISH TRAIL	GAUTIER	MS	39553	10/04/2021	01/01/2022		01/01/2022
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK ILLINOIS MAIL PHARMACY, LLC	DBA CVS/CAREMARK OR CARELONRX MAIL #8702	800 BIERMANN COURT SUITE A	MOUNT PROSPECT	IL	60056	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CONWELL'S PHARMACY	PO BOX 1297	10835 DAUPHIN ISLAND PARKWAY	THEODORE	AL	36590-1297	01/12/2015	04/01/2015		01/12/2015
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 7193	2314 EAST EXPRESSWAY 83	MISSION	TX	78572	10/04/2021	01/01/2022		01/01/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/13/2022	10/01/2022		10/01/2022
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/04/2018	04/01/2018		01/04/2018
Contract Detail	FRED'S PHARMACY # 1159	13210 N WINTZELL AVE		BAYOU LA BATRE	AL	36509-2142	01/23/2017	04/01/2017	12/20/2022	12/27/2022
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16620	1749 E NINE MILE RD	PENSACOLA	FL	32514	10/04/2021	01/01/2022		01/01/2022
Contract Detail	J. WATKINS DRUGS	13286 N WINTZELL AVE		BAYOU LA BATRE	AL	36509	07/10/2024	10/01/2024		10/01/2024
Contract Detail	LLOYD'S PHARMACY, INC.	13286 N WINTZELL AVE		BAYOU LA BATRE	AL	36509-2146	10/16/2014	01/01/2015	01/11/2018	01/11/2018
Contract Detail	MCCONAGHY DRUGS	MCCONAGHY DRUGS	5565 HIGHWAY 43 P.O.BOX 488	SATSUMA	AL	36572	07/07/2014	10/01/2014	12/20/2022	12/27/2022
Contract Detail	MCINTOSH DRUGS	7771 HIGHWAY 43		MC INTOSH	AL	36553	01/17/2014	04/01/2014	12/20/2022	12/27/2022
Contract Detail	MILLRY DRUGS	30282 HWY 17	P.O. BOX 199	MILLRY	AL	36558	07/07/2014	10/01/2014	12/20/2022	12/27/2022
Contract Detail	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01119	7021 HWY 614, PO BOX 789	HURLEY	MS	39555	10/04/2021	01/01/2022		01/01/2022
Contract Detail	MT VERNON PHARMACY	19390 HIGHWAY 43		MOUNT VERNON	AL	36560-3450	07/07/2014	10/01/2014	12/20/2022	12/27/2022
Contract Detail	NEW GRAND BAY PHARMACY, LLC	DBA GRAND BAY PHARMACY	10067 GRAND BAY WILMER RD S	GRAND BAY	AL	36541	01/17/2014	04/01/2014	01/11/2018	01/11/2018
Contract Detail	NEW GRAND BAY PHARMACY, LLC	DBA GRAND BAY PHARMACY	10067 GRAND BAY WILMER RD S	GRAND BAY	AL	36541	01/05/2021	04/01/2021		04/01/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/04/2018	04/01/2018	04/13/2023	04/13/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/15/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/13/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/13/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/13/2022	10/01/2022		10/01/2022
Contract Detail	SEMMES PHARMACY, LLC DBA SEMMES PHARMACY	8985 MOFFETT RD		SEMMES	AL	36575	10/19/2015	01/01/2016	11/13/2024	02/20/2025
Contract Detail	THREE NOTCH PHARMACY, LLC	DBA THREE NOTCH PHARMACY	7700 THREE NOTCH RD	MOBILE	AL	36619	10/14/2015	01/01/2016	11/13/2024	02/20/2025
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-0866	5245 RANGELINE SERVICE RD S		MOBILE	AL	36619-9541	10/17/2014	01/01/2015		10/17/2014
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10982	2501 COLLEGE AVENUE	JACKSON	AL	36545	01/04/2018	04/01/2018	01/10/2025	02/20/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07609	2050 GOVERNMENT STREET	MOBILE	AL	36606-1622	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07962	12 SHELTON BEACH RD	SARALAND	AL	36571-2403	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06085	5530 THREE NOTCH RD	MOBILE	AL	36619	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13159	9179 MOFFETT RD.	SEMMES	AL	36575	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10168	12550 HWY 90	GRAND BAY	AL	36541-5609	01/04/2018	04/01/2018		01/04/2018
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/04/2022	07/01/2022		07/01/2022
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/04/2018	04/01/2018		01/04/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/04/2018	04/01/2018	04/13/2023	04/13/2023
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/04/2018	04/01/2018		01/04/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH044700	Active	BPS-H80-004489	Bayou La Batre Area Health Development Board, Inc	MOSTELLAR MEDICAL CENTER	12701 PADGETT SWITCH ROAD		IRVINGTON	AL
CH04470A	Active	BPS-H80-005224	Bayou La Batre Area Health Development Board, Inc	SOUTHWEST ALABAMA HEALTH SERVICE	7777 HIGHWAY 43 NORTH		MCINTOSH	AL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06017	12900 N. WINTZELL AVE.	BAYOU LA BATRE	AL	36509	01/01/2017
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04782	10115 GRAND BAY WILMER RD. SOUTH	GRAND BAY	AL	36541	04/01/2018
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04877	2280 DR. MARTIN LUTHER KING JR AVE	MOBILE	AL	36610	01/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04883	9151 MOFFETT RD	SEMMES	AL	36575	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04877	2280 DR. MARTIN LUTHER KING JR AVE	MOBILE	AL	36610	01/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07671	1401 HILLCREST RD	MOBILE	AL	36695-4032	01/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02567	7081 AIRPORT RD	MOBILE	AL	36608	01/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10181	5400 HWY 280	HOOVER	AL	35242	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04883	9151 MOFFETT RD	SEMMES	AL	36575	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04818	4881 SCHILLINGER RD. S	MOBILE	AL	36619	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07671	1401 HILLCREST RD	MOBILE	AL	36695-4032	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02675	900 GOVERNMENT ST.	MOBILE	AL	36604	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06017	12900 N. WINTZELL AVE.	BAYOU LA BATRE	AL	36509	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10181	5400 HWY 280	HOOVER	AL	35242	01/01/2022
CH04470A	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02567	7081 AIRPORT RD	MOBILE	AL	36608	01/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02675	900 GOVERNMENT ST.	MOBILE	AL	36604	01/01/2022	11/30/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04818	4881 SCHILLINGER RD. S	MOBILE	AL	36619	10/01/2022
CH044700	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07668	19215 NORTH 3RD ST.	CITRONELLE	AL	36522	10/01/2024
CH044700	B & F DRUGS		16900 JORDAN STREET PO BOX 807	CHATOM	AL	36518	04/01/2015
CH044700	BAYOU PHARMACY LLC DBA BAYOU PHARMACY	12855 PADGETT SWITCH RD		IRVINGTON	AL	36544-4015	04/01/2014
CH044700	CARECENTER PHARMACY, L.L.C.	CAREPLUS CVS/PHARMACY #10923	2105 OLD SPANISH TRAIL	GAUTIER	MS	39553	01/01/2022
CH04470A	CARECENTER PHARMACY, L.L.C.	CAREPLUS CVS/PHARMACY #10923	2105 OLD SPANISH TRAIL	GAUTIER	MS	39553	01/01/2022
CH044700	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2022
CH044700	CAREMARK ILLINOIS MAIL PHARMACY, LLC	DBA CVS/CAREMARK OR CARELONRX MAIL #8702	800 BIERMANN COURT SUITE A	MOUNT PROSPECT	IL	60056	10/01/2022
CH044700	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2022
CH044700	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2022
CH044700	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2022
CH044700	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2022
CH044700	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2022
CH044700	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2022
CH044700	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2022
CH044700	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2022
CH044700	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2022
CH044700	CONWELL'S PHARMACY	PO BOX 1297	10835 DAUPHIN ISLAND PARKWAY	THEODORE	AL	36590-1297	04/01/2015
CH044700	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
CH04470A	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 7193	2314 EAST EXPRESSWAY 83	MISSION	TX	78572	01/01/2022
CH044700	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 7193	2314 EAST EXPRESSWAY 83	MISSION	TX	78572	01/01/2022
CH044700	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2022
CH044700	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2018
CH044700	FRED'S PHARMACY # 1159	13210 N WINTZELL AVE		BAYOU LA BATRE	AL	36509-2142	04/01/2017	12/20/2022
CH04470A	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16620	1749 E NINE MILE RD	PENSACOLA	FL	32514	01/01/2022
CH044700	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16620	1749 E NINE MILE RD	PENSACOLA	FL	32514	01/01/2022
CH044700	J. WATKINS DRUGS	13286 N WINTZELL AVE		BAYOU LA BATRE	AL	36509	10/01/2024
CH044700	LLOYD'S PHARMACY, INC.	13286 N WINTZELL AVE		BAYOU LA BATRE	AL	36509-2146	01/01/2015	01/11/2018
CH044700	MCCONAGHY DRUGS	MCCONAGHY DRUGS	5565 HIGHWAY 43 P.O.BOX 488	SATSUMA	AL	36572	10/01/2014	12/20/2022
CH044700	MCINTOSH DRUGS	7771 HIGHWAY 43		MC INTOSH	AL	36553	04/01/2014	12/20/2022
CH044700	MILLRY DRUGS	30282 HWY 17	P.O. BOX 199	MILLRY	AL	36558	10/01/2014	12/20/2022
CH04470A	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01119	7021 HWY 614, PO BOX 789	HURLEY	MS	39555	01/01/2022
CH044700	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01119	7021 HWY 614, PO BOX 789	HURLEY	MS	39555	01/01/2022
CH044700	MT VERNON PHARMACY	19390 HIGHWAY 43		MOUNT VERNON	AL	36560-3450	10/01/2014	12/20/2022
CH044700	NEW GRAND BAY PHARMACY, LLC	DBA GRAND BAY PHARMACY	10067 GRAND BAY WILMER RD S	GRAND BAY	AL	36541	04/01/2014	01/11/2018
CH044700	NEW GRAND BAY PHARMACY, LLC	DBA GRAND BAY PHARMACY	10067 GRAND BAY WILMER RD S	GRAND BAY	AL	36541	04/01/2021
CH044700	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2018	04/13/2023
CH044700	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2022
CH044700	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2022
CH044700	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2022
CH044700	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2022
CH044700	SEMMES PHARMACY, LLC DBA SEMMES PHARMACY	8985 MOFFETT RD		SEMMES	AL	36575	01/01/2016	11/13/2024
CH044700	THREE NOTCH PHARMACY, LLC	DBA THREE NOTCH PHARMACY	7700 THREE NOTCH RD	MOBILE	AL	36619	01/01/2016	11/13/2024
CH044700	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH044700	WAL-MART PHARMACY 10-0866	5245 RANGELINE SERVICE RD S		MOBILE	AL	36619-9541	01/01/2015
CH044700	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH044700	WALGREEN CO	DBA: WALGREENS #10982	2501 COLLEGE AVENUE	JACKSON	AL	36545	04/01/2018	01/10/2025
CH044700	WALGREEN CO.	DBA: WALGREENS # 07609	2050 GOVERNMENT STREET	MOBILE	AL	36606-1622	04/01/2018
CH044700	WALGREEN CO.	DBA: WALGREENS # 07962	12 SHELTON BEACH RD	SARALAND	AL	36571-2403	04/01/2018
CH044700	WALGREEN CO.	DBA: WALGREENS # 06085	5530 THREE NOTCH RD	MOBILE	AL	36619	04/01/2018
CH044700	WALGREEN CO.	DBA: WALGREENS #13159	9179 MOFFETT RD.	SEMMES	AL	36575	04/01/2018
CH044700	WALGREEN CO.	DBA: WALGREENS # 10168	12550 HWY 90	GRAND BAY	AL	36541-5609	04/01/2018
CH044700	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH044700	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018
CH044700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2018
CH044700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2018
CH044700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2018
CH044700	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2018	04/13/2023
CH044700	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 11:28:59 AM	2/20/2025 9:45:11 AM	2/20/2025 9:45 AM
Details	Last Recertification Date	Update	Recertification	2/2/2023 2:35:18 PM	2/6/2024 11:28:59 AM	2/6/2024 11:28 AM
Details	Last Recertification Date	Update	Recertification	2/7/2022 1:41:47 PM	2/2/2023 2:35:18 PM	2/2/2023 2:35 PM
Details	Last Recertification Date	Update	Recertification	2/2/2021 7:38:05 AM	2/7/2022 1:41:47 PM	2/7/2022 1:41 PM
Details	Last Recertification Date	Update	Recertification	2/18/2020 6:42:09 AM	2/2/2021 7:38:05 AM	2/2/2021 7:38 AM
Contacts	Primary Contact	Update	Recertification	EDWARDS, BETH DIRECTOR OF OPERATIONS Bayou La Batre Area Health Development Board, Inc. 2518242174-5275	Stork, Todd COO Bayou La Batre Area Health Development Board Inc. 2518242174-5275	2/18/2020 6:42 AM
Details	Last Recertification Date	Update	Recertification	2/4/2019 10:53:26 AM	2/18/2020 6:42:09 AM	2/18/2020 6:42 AM
Contacts	Authorizing Official	Update	AO Change Request	Stork, Todd COO Bayou La Batre Area Health Development Board Inc. 2518242174-5275	HOLLAND, JAMES A. CEO Bayou La Batre Area Health Development Board, Inc. 2518242174-5229	2/14/2020 2:30 PM
Contacts	Authorizing Official	Update	AO Change Request	HOLLAND, JAMES A. CEO Bayou La Batre Area Health Development Board, Inc. 2518242174-5229	Stork, Todd COO Bayou La Batre Area Health Development Board Inc. 2518242174-5275	1/29/2020 9:14 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 3:35:16 PM	2/4/2019 10:53:26 AM	2/4/2019 10:53 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/7/2018 3:35:16 PM	2/7/2018 3:35 PM
Contacts	Authorizing Official	Update		HOLLAND, JAMES A. CEO 2518242174-5229	HOLLAND, JAMES A. CEO Bayou La Batre Area Health Development Board, Inc. 2518242174-5229	1/4/2018 2:33 PM
Contacts	Primary Contact	Update		EDWARDS, BETH DIRECTOR OF OPERATIONS 2518242174-5275	EDWARDS, BETH DIRECTOR OF OPERATIONS Bayou La Batre Area Health Development Board, Inc. 2518242174-5275	9/21/2017 11:13 AM
Contacts	Authorizing Official	Insert			HOLLAND, JAMES A. CEO 2518242174-5229	7/18/2017 10:43 AM
Addresses	Main Address	Insert			12701 PADGETT SWITCH ROAD IRVINGTON, AL 36544-4011	2/1/2017 3:06 PM
Contacts	Primary Contact	Insert			EDWARDS, BETH DIRECTOR OF OPERATIONS 2518242174-5275	2/1/2017 3:06 PM
Details	Last Recertification Date	Update		2/17/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 3:06 PM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/17/2016 12:00:00 AM	2/17/2016 11:29 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 12:54 PM
Details	Entity Subname	Update		BAYOU LA BATRE AREA HEALTH DEVELOPMENT B	MOSTELLAR MEDICAL CENTER	11/12/2014 11:55 AM
Details	Comments Public	Insert			11/12/14 corrected site ID to the EHB record for the service delivery site (from the Admin-only EHB site) and updated the corresponding address fields	11/12/2014 11:55 AM
Details	Entity Name	Update		AREA HEALTH DEVELOPMENT BOARD, INC.	Bayou La Batre Area Health Development Board, Inc	3/31/2014 4:25 PM
Details	Entity Subname	Update		MOSTELLAR MEDICAL CENTER	BAYOU LA BATRE AREA HEALTH DEVELOPMENT B	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 11:26 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/28/2013 10:20 AM
Details	Last Recertification Date	Insert				9/12/2002 12:00 AM
Details	Grant Number	Insert			H80CS00098	9/12/2002 12:00 AM
Details	340B ID	Insert			CH044700	9/12/2002 12:00 AM
Details	Is Authorizing Official EHB Data	Insert				9/12/2002 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/12/2002 12:00 AM
Details	Medicare Provider Number	Insert				9/12/2002 12:00 AM
Details	Entity Name	Insert			AREA HEALTH DEVELOPMENT BOARD, INC.	9/12/2002 12:00 AM
Details	Program Code	Insert			CH	9/12/2002 12:00 AM
Details	Entity Subname	Insert			MOSTELLAR MEDICAL CENTER	9/12/2002 12:00 AM
Dates	Participating Approval Date	Insert			7/1/2001 12:00:00 AM	9/12/2002 12:00 AM
Details	State	Insert			Active	9/12/2002 12:00 AM
Dates	Registration Date	Insert			7/1/2001 12:00:00 AM	9/12/2002 12:00 AM
Dates	Signed By Date	Insert				9/12/2002 12:00 AM
Dates	Start Date	Insert			7/1/2001 12:00:00 AM	9/12/2002 12:00 AM
Terminations	Termination Comments	Insert				9/12/2002 12:00 AM
Terminations	Termination Date	Insert				9/12/2002 12:00 AM
Terminations	Termination Effective Date	Insert				9/12/2002 12:00 AM
Terminations	Termination Reason	Insert				9/12/2002 12:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History