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FRED'S PHARMACY # 1159
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
FRED'S PHARMACY # 1159
Pharmacy Address
13210 N WINTZELL AVE
BAYOU LA BATRE, AL 36509-2142
Pharmacy Comments
Contract Details
Approval Date
1/23/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/20/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
1/23/2017
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