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BAYOU PHARMACY LLC DBA BAYOU PHARMACY
CH044700 Bayou La Batre Area Health Development Board, Inc
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Covered Entity Details
Entity Name
Bayou La Batre Area Health Development Board, Inc
Subdivision Name
MOSTELLAR MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH044700
Entity Address
12701 PADGETT SWITCH ROAD
IRVINGTON, AL 36544-4011
Grant Number
H80CS00098
Participating Start Date
7/1/2001
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
BAYOU PHARMACY LLC DBA BAYOU PHARMACY
Pharmacy Address
12855 PADGETT SWITCH RD
IRVINGTON, AL 36544-4015
Pharmacy Comments
Contract Details
Approval Date
1/17/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229
Contract Pharmacy Representative
Semmes Pharmacy
Charles Cottrell, Owner
(251) 824-7979
Signed By Date
1/17/2014
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