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WINN-DIXIE #543
CH042850 RURAL HEALTH MEDICAL PROGRAM, INC.
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Covered Entity Details
Entity Name
RURAL HEALTH MEDICAL PROGRAM, INC.
Subdivision Name
Rural Health Medical Program, Inc.-Selma Health Center & Administrative Office
Type
HRSA-Funded Health Center
340B ID
CH042850
Entity Address
101 PARK PLACE
SELMA, AL 36701
Grant Number
H80CS00794
Participating Start Date
1/1/2003
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WINN-DIXIE #543
Pharmacy Address
1952 W. DALLAS AVE
SELMA, AL 36701
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
KESHEE Danee DOZIER-SMITH, CEO
(334) 874-7428 Ext: 121
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
1/11/2018
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