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MIKE'S SOUTHSIDE PHARMACY
CH048950 SE ALABAMA RURAL HEALTH ASSOCIATES (SARHA)
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Covered Entity Details
Entity Name
SE ALABAMA RURAL HEALTH ASSOCIATES (SARHA)
Subdivision Name
Administrative Offices
Type
HRSA-Funded Health Center
340B ID
CH048950
Entity Address
1414 Elba Hwy
Troy, AL 36079-6020
Grant Number
H80CS00376
Participating Start Date
7/1/1996
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
4/28/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOHN A. LITTLE, CEO
(334) 670-6726
Contract Pharmacy Representative
Mike's Southside Pharmacy
Mike Pitzing, Owner
(334) 701-9549
Signed By Date
4/28/2014
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