| Name: | Carroll Total Care Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 15 Feb 1995 (30 years ago) |
| Entity Number: | 000-169-944 |
| Register Number: | 000169944 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | TRUSSVILLE, AL |
| Registered Office Street Address: | 100 BLACK WALNUT LANETRUSSVILLE, AL 35173 |
| Registered Office Street Address ZIP Code: | 35173 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
TO DISPENSE PHARMACEUTICAL CARE/DRUG STORE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265582688 | 2007-01-10 | 2019-01-15 | 6767 OLD SPRINGVILLE RD, PINSON, AL, 351263039, US | 6767 OLD SPRINGVILLE RD, PINSON, AL, 351263039, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-680-5557 |
| Fax | 2056805502 |
Authorized person
| Name | MR. GREG W CARROLL |
| Role | C.E.O |
| Phone | 2056805557 |
Taxonomy
| Taxonomy Code | 163WD0400X - Diabetes Educator Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 110500 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1000002717 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARROLL TOTAL CARE PHARMACY (VISION PLAN) | 2022 | 631138122 | 2023-07-27 | CARROLL TOTAL CARE PHARMACY | 1 | |||||||||||||||||||||||||||||||||||||
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| 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 | 2059561836 |
| Plan sponsor’s address | PO BOX 252, CLAY, AL, 35048 |
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 | 2022-07-21 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2022-07-21 |
| 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 | 2059561836 |
| Plan sponsor’s address | PO BOX 252, CLAY, AL, 35048 |
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 | 2021-10-09 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2021-10-09 |
| Name of individual signing | W. HAL SHEPHERD |
| Name | Role |
|---|---|
| CARROLL, GREGORY WADE | Agent |
| Name | Role |
|---|---|
| CARROLL, GREGORY WADE | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
