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JACK'S DISCOUNT PHARMACY
HV00595 Whatley Health Services, Inc.
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Covered Entity Details
Entity Name
Whatley Health Services, Inc.
Subdivision Name
Maude L. Whatley Health Center
Type
Ryan White Part C
340B ID
HV00595
Entity Address
2731 Martin Luther King Jr. Blvd
Tuscaloosa, AL 35401-5235
Grant Number
H76HA00595
Participating Start Date
4/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
JACK'S DISCOUNT PHARMACY
Pharmacy Address
JACK'S DISCOUNT PHARMACY
23010 HIGHWAY 5
PO BOX 680
WEST BLOCTON, AL 35184-3522
Pharmacy Comments
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2019
CE terminated due to audit finding
Contacts
Covered Entity Signing Official
Deborah H. Tucker, CEO
(205) 349-3250 Ext: 6135
Contract Pharmacy Representative
Neil Hitchcock, President
(205) 938-9591
Signed By Date
1/10/2014
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