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MIKE'S PHARMACY OF HEADLAND, INC
CH04895D SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
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Covered Entity Details
Entity Name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Subdivision Name
ENTERPRISE CHILDREN'S CENTER AND FAMILY MEDICINE
Type
HRSA-Funded Health Center
340B ID
CH04895D
Entity Address
105 E Watts St
Enterprise, AL 36330-2511
Grant Number
H80CS00376
Participating Start Date
1/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MIKE'S PHARMACY OF HEADLAND, INC
Pharmacy Address
202 HOLMAN DR
HEADLAND, AL 36345
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamylon Bowers, Chief Executive Officer
(334) 670-6726 Ext: 173
Contract Pharmacy Representative
Mike's Southside Pharmacy
Mike Pitzing, Owner
(334) 701-9549
Signed By Date
10/5/2023
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