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MIKE'S SOUTHSIDE PHARMACY
CH04895M Southeast Alabama Rural Health Associates
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Covered Entity Details
Entity Name
Southeast Alabama Rural Health Associates
Subdivision Name
Dothan Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH04895M
Entity Address
4300 West Main Street
Suite 300
Dothan, AL 36305
Grant Number
H80CS00376
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MIKE'S SOUTHSIDE PHARMACY
Pharmacy Address
1006 S. OATES ST.
DOTHAN, AL 36301
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
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
10/9/2023
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