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WAL-MART PHARMACY 10-0866
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
WAL-MART PHARMACY 10-0866
Pharmacy Address
5245 RANGELINE SERVICE RD S
MOBILE, AL 36619-9541
Pharmacy Comments
Contract Details
Approval Date
10/17/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/17/2014
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