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WINN DIXIE
CH040130 HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
HEALTH SERVICES, INC.
Subdivision Name
River Region
Type
HRSA-Funded Health Center
340B ID
CH040130
Entity Address
1845 CHERRY STREET
MONTGOMERY, AL 36107
Grant Number
H80CS00795
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE
Pharmacy Address
DBA WINN-DIXIE PHARMACY #446
4724 MOBILE HWY
MONTGOMERY, AL 36108
Pharmacy Comments
Contract Details
Approval Date
2/22/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bernell C. Mapp, CEO
(334) 265-2454
Contract Pharmacy Representative
John Fegen, VP of Pharmacy
(904) 783-5020
Signed By Date
1/14/2013
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