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MIZELLES DISCOUNT DRUG CO INC
CH049190 BERTIE COUNTY RURAL HEALTH ASSOCIATION
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Covered Entity Details
Entity Name
BERTIE COUNTY RURAL HEALTH ASSOCIATION
Subdivision Name
WINDSOR COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH049190
Entity Address
104 RHODES AVENUE
WINDSOR, NC 27983
Grant Number
H80CS00355
Participating Start Date
10/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
MIZELLES DISCOUNT DRUG CO INC
Pharmacy Address
LOUIS E MIZELLE JR
925 E MEMORIAL DRIVE
AHOSKIE, NC 27910
Pharmacy Comments
Contract Details
Approval Date
8/11/2010
Contract Begin Date
8/11/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2016
Ownership change
Contacts
Covered Entity Signing Official
ALBERT THOMPSON, CEO
(252) 794-1835 Ext: 226
Contract Pharmacy Representative
Louis Mizelle, President
(252) 332-5034
Signed By Date
8/4/2010
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