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Courtland Discount Pharmacy, Inc.

Details

Name: Courtland Discount Pharmacy, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 15 Oct 1997 (27 years ago) (Companies founded in October 1997)
Date of dissolution: 21 Nov 2016
Entity Number: 000-190-865
Register Number: 000190865
ZIP code: 35671 (Companies in Limestone, 35671)
County: Limestone
Place of Formation: Lawrence County
Principal Address: TANNER, AL
Registered Office Street Address: 11234 DRENNEN DRTANNER, AL 35671
Authorized Capital: $5,000

Activities DRUG STORE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1871674614 2006-10-18 2023-03-07 369 HAMILTON STREET, COURTLAND, AL, 35618, US 369 HAMILTON STREET, COURTLAND, AL, 35618, US

Contacts
Phone +1 256-637-8050
Fax 2566378052

Authorized person
Name MRS. TAMMY V GARRETT
Role OWNER SUPERVISING PHARMACIST
Phone 2566378050

Taxonomy
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 100002934
State AL
Issuer SALES TAX #
Number 400004465
State AL
Issuer NCPDP
Number 0127755
State AL
Issuer MEDICAID
Number 009985880
State AL
Issuer STATE PERMIT
Number 111155
State AL
Issuer BCBS BILLING ID
Number WEB1CDPH
State AL
Issuer BCBS DME
Number 51099925
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COURTLAND DISCOUNT PHARMACY 401(K) PROFIT SHARING PLAN 2015 721396368 2016-09-12 COURTLAND DISCOUNT PHARMACY, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Signature of
Role Plan administrator
Date 2016-09-12
Name of individual signing TAMMY GARRETT
COURTLAND DISCOUNT PHARMACY 401(K) PROFIT SHARING PLAN 2014 721396368 2015-05-11 COURTLAND DISCOUNT PHARMACY, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Signature of
Role Plan administrator
Date 2015-05-11
Name of individual signing TAMMY GARRETT
COURTLAND DISCOUNT PHARMACY 401(K) PROFIT SHARING PLAN 2013 721396368 2014-09-15 COURTLAND DISCOUNT PHARMACY, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Signature of
Role Plan administrator
Date 2014-09-15
Name of individual signing TAMMY GARRETT
COURTLAND DISCOUNT PHARMACY 401(K) SAFE HARBOR WITH DISCRETIONARY PROFIT SHARING PLAN 2012 721396368 2013-10-07 COURTLAND DISCOUNT PHARMACY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Plan administrator’s name and address
Administrator’s EIN 721396368
Plan administrator’s name COURTLAND DISCOUNT PHARMACY, INC.
Plan administrator’s address 369 HAMILTON STREET, COURTLAND, AL, 35618
Administrator’s telephone number 2566378050

Signature of
Role Plan administrator
Date 2013-10-07
Name of individual signing TAMMY GARRETT
COURTLAND DISCOUNT PHARMACY 401(K) SAFE HARBOR WITH DISCRETIONARY PROFIT SHARING PLAN 2011 721396368 2012-06-25 COURTLAND DISCOUNT PHARMACY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Plan administrator’s name and address
Administrator’s EIN 721396368
Plan administrator’s name COURTLAND DISCOUNT PHARMACY, INC.
Plan administrator’s address 369 HAMILTON STREET, COURTLAND, AL, 35618
Administrator’s telephone number 2566378050

Signature of
Role Plan administrator
Date 2012-06-22
Name of individual signing TAMMY GARRETT
COURTLAND DISCOUNT PHARMACY 401(K) SAFE HARBOR WITH DISCRETIONARY PS PLAN 2010 721396368 2011-07-14 COURTLAND DISCOUNT PHARMACY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 446110
Sponsor’s telephone number 2566378050
Plan sponsor’s address 369 HAMILTON STREET, COURTLAND, AL, 35618

Plan administrator’s name and address
Administrator’s EIN 721396368
Plan administrator’s name COURTLAND DISCOUNT PHARMACY, INC.
Plan administrator’s address 369 HAMILTON STREET, COURTLAND, AL, 35618
Administrator’s telephone number 2566378050

Signature of
Role Plan administrator
Date 2011-07-14
Name of individual signing TAMMY GARRETT

Agent

Name Role Address
GARRETT, TAMMY Agent 11964 ESCUE DRIVE SUITE ATANNER, AL 35671

Incorporator

Name Role
BENDALL, JACK G Incorporator

Related by officers

GARRETT, TAMMY

Southside Pharmacy, Inc.

BENDALL, JACK G

Westmeade Pharmacy, Inc. Bendall's Pharmacy, Inc.

Related by address

TANNER, AL

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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