Contract Pharmacy Details

CITY DRUG
FQHCLA429 Physicians Care of Clarke

Covered Entity Details

Entity Name

Physicians Care of Clarke

Subdivision Name

Fulton Family Medical

Type

Health Center Program Look-Alike

340B ID

FQHCLA429

Entity Address

218 Main St
Fulton, AL 36446-0065

Grant Number

LALCS43504

Participating Start Date

1/1/2022

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

CITY DRUG

Pharmacy Address

123 JACKSON ST
PO BOX 790
GROVE HILL, AL 36451

Pharmacy Comments

Contract Details

Approval Date

10/13/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FARRELL A TURNER, CEO
(256) 201-0095

Contract Pharmacy Representative

City Drugs
Brooks Davis, Owner
(251) 275-3669

Signed By Date

10/13/2021