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LOCUST FORK PHARMACY LLC
CH044120 QUALITY OF LIFE HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
QUALITY OF LIFE HEALTH SERVICES, INC.
Subdivision Name
QUALITY OF LIFE HEALTH COMPLEX
Type
HRSA-Funded Health Center
340B ID
CH044120
Entity Address
1411 PIEDMONT CUTOFF
GADSDEN, AL 35903-2708
Grant Number
H80CS00658
Participating Start Date
12/1/1992
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
LOCUST FORK PHARMACY LLC
Pharmacy Address
LOCUST FORK PHARMACY
29984 STATE HIGHWAY 79 STE 600
LOCUST FORK, AL 35097-5879
Pharmacy Comments
Contract Details
Approval Date
4/23/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/4/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
WAYNE ROWE, CEO
(256) 492-0131
Contract Pharmacy Representative
Johnny Cleveland, Pharmacist
(205) 680-2222
Signed By Date
4/23/2015
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