Redmont Pharmacy, Inc.

Contacts

Phone	+1 256-356-9000
Fax	2563569060

Authorized person

Name	JAMES WEEKS
Role	OWNER/PRESIDENT/PIC/AO
Phone	2563569000

Taxonomy

Taxonomy Code	332B00000X - Durable Medical Equipment & Medical Supplies
License Number	14425/7.1
State	MS
Is Primary	No
Taxonomy Code	333600000X - Pharmacy
Is Primary	No
Taxonomy Code	3336C0003X - Community/Retail Pharmacy
License Number	108330
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	00030214
State	MS
Issuer	MEDICAID
Number	009919100
State	AL
Issuer	PK
Number	1990901
Issuer	MEDICAID
Number	100001897
State	AL
Issuer	MEDICAID
Number	0040386
State	MS

File	View Page
Three-digit plan number (PN)	951
Effective date of plan	2020-10-01
Business code	446110
Sponsor’s telephone number	8669665457
Plan sponsor’s address	P. O. BOX 1487, RED BAY, AL, 35582

Plan administrator’s name and address

Administrator’s EIN	472506773
Plan administrator’s name	KENNION & CO, LLC
Plan administrator’s address	2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number	8669665457

Signature of

Role	Plan administrator
Date	2023-07-18
Name of individual signing	W. HAL SHEPHERD
Role	Employer/plan sponsor
Date	2023-07-18
Name of individual signing	W. HAL SHEPHERD

File	View Page
Three-digit plan number (PN)	951
Effective date of plan	2020-10-01
Business code	446110
Sponsor’s telephone number	8669665457
Plan sponsor’s address	P. O. BOX 1487, RED BAY, AL, 35582

Plan administrator’s name and address

Administrator’s EIN	472506773
Plan administrator’s name	KENNION & CO, LLC
Plan administrator’s address	2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number	8669665457

Signature of

Role	Plan administrator
Date	2022-07-20
Name of individual signing	W. HAL SHEPHERD
Role	Employer/plan sponsor
Date	2022-07-20
Name of individual signing	W. HAL SHEPHERD

File	View Page
Three-digit plan number (PN)	951
Effective date of plan	2020-10-01
Business code	446110
Sponsor’s telephone number	8669665457
Plan sponsor’s address	P. O. BOX 1487, RED BAY, AL, 35582

Plan administrator’s name and address

Administrator’s EIN	472506773
Plan administrator’s name	KENNION & CO, LLC
Plan administrator’s address	2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243
Administrator’s telephone number	8669665457

Signature of

Role	Plan administrator
Date	2021-07-23
Name of individual signing	W. HAL SHEPHERD
Role	Employer/plan sponsor
Date	2021-07-23
Name of individual signing	W. HAL SHEPHERD