340B Drug Pricing Program Database

Name

BAYOUCLINIC, INC.

Subdivision Name

BayouClinic, Inc.

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-010904

340B ID

FQHCLA336

Grant Number

LALCS00109

Current Program Status

Terminated

Registration Date

10/13/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/30/2015

Last Recertification Date

2/9/2018

Termination Date
Termination Reason

1/1/2019
Change of covered entity type (non-hospital)

Authorizing Official

BayouClinic, Inc.
Julie Taylor, Executive Director
(251) 824-4985

Primary Contact

BayouClinic, Inc.
Heather Smith, Practice Manager
(251) 824-4985

Street Address

13833 Tapia Lane
Bayou La Batre, AL 36509-2515

Billing Address
Same as Street Address