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NEW GRAND BAY PHARMACY, LLC
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
NEW GRAND BAY PHARMACY, LLC
Pharmacy Address
DBA GRAND BAY PHARMACY
10067 GRAND BAY WILMER RD S
GRAND BAY, AL 36541
Pharmacy Comments
Contract Details
Approval Date
1/5/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229
Contract Pharmacy Representative
New Grand Bay Pharmacy, LLC
Charles Cottrell, President
(251) 865-5555
Signed By Date
1/5/2021
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