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WINN DIXIE PHARMACY #1333
CH047080 MOBILE COUNTY BOARD OF HEALTH
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Covered Entity Details
Entity Name
MOBILE COUNTY BOARD OF HEALTH
Subdivision Name
FAMILY ORIENTED PRIMARY HEALTH CARE CLIN
Type
HRSA-Funded Health Center
340B ID
CH047080
Entity Address
251 N Bayou St
Mobile, AL 36603-5827
Grant Number
H80CS00318
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY #1333
Pharmacy Address
1550 GOVERNMENT STREET
MOBILE, AL 36604
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/14/2023
Ownership change
Contacts
Covered Entity Signing Official
Angelia Lewis, CEO
(251) 690-8832
Contract Pharmacy Representative
BILO
DAVID CHISM, SR. DIRECTOR
(904) 370-6455
Signed By Date
4/16/2018
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