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WIREGRASS COMM PHARMACY
CH04895N SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
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Covered Entity Details
Entity Name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Subdivision Name
Geneva Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH04895N
Entity Address
100 W Lake Professional Park Ste 3
Geneva, AL 36340-1200
Grant Number
H80CS00376
Participating Start Date
4/22/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WIREGRASS COMM PHARMACY
Pharmacy Address
PO BOX 367
430 BROADWAY
ASHFORD, AL 36312-0367
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/10/2023
Ownership change
Contacts
Covered Entity Signing Official
Pamylon Bowers, Chief Executive Officer
(334) 670-6726 Ext: 173
Contract Pharmacy Representative
Scott Cook Pharmacy
Marvin Cook, Owner
(334) 712-2000
Signed By Date
10/9/2023
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