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Hayden Family Pharmacy, P.C.

Details

Name: Hayden Family Pharmacy, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 08 Jul 2003 (21 years ago) (Companies founded in July 2003)
Entity Number: 000-229-953
Register Number: 000229953
ZIP code: 35180 (Companies in Jefferson, 35180)
County: Jefferson
Place of Formation: Blount County
Principal Address: WARRIOR, AL
Registered Office Street Address: 405 SKYVIEW LAKE RDWARRIOR, AL 35180
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities PHARMACEUTICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1063792018 2011-08-23 2020-09-13 PO BOX 665, HAYDEN, AL, 350790665, US 88 WHITE OAK TRL, WARRIOR, AL, 351804214, US

Contacts
Phone +1 205-590-1100
Fax 2055901120

Authorized person
Name JENNIFER METCALF
Role PRESIDENT
Phone 2055901100

Taxonomy
Taxonomy Code 333600000X - Pharmacy
Is Primary No
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
License Number 113797
State AL
Is Primary Yes

Other Provider Identifiers
Issuer CLIA
Number 01D2107084
State AL
Issuer PK
Number 2131605
Issuer MEDICAID
Number 1063792018
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2023 861071895 2024-09-18 HAYDEN FAMILY PHARMACY, P.C. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901515
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2024-06-20
Name of individual signing HAYDENPHARMACY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-18
Name of individual signing HAYDENPHARMACY
Valid signature Filed with incorrect/unrecognized electronic signature
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2022 861071895 2023-06-24 HAYDEN FAMILY PHARMACY, P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901515
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2023-06-24
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2023-06-24
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2021 861071895 2022-04-25 HAYDEN FAMILY PHARMACY, P.C. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901515
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2022-04-25
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2022-04-25
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2020 861071895 2021-05-01 HAYDEN FAMILY PHARMACY, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901515
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2021-05-01
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2021-05-01
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2019 861071895 2020-04-27 HAYDEN FAMILY PHARMACY, P.C. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2020-04-27
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2020-04-27
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2018 861071895 2019-08-05 HAYDEN FAMILY PHARMACY, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2019-08-05
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2019-08-05
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2017 861071895 2018-08-14 HAYDEN FAMILY PHARMACY, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2018-08-14
Name of individual signing JENNIFER S METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2016 861071895 2017-10-10 HAYDEN FAMILY PHARMACY, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2017-10-10
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2017-10-10
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2015 861071895 2016-09-23 HAYDEN FAMILY PHARMACY, P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address PO BOX 665, HAYDEN, AL, 35079

Signature of
Role Plan administrator
Date 2016-09-23
Name of individual signing JENNIFER METCALF
Role Employer/plan sponsor
Date 2016-09-23
Name of individual signing JENNIFER METCALF
HAYDEN HEALTH MART PHARMACY 401(K) PLAN 2014 861071895 2015-09-03 HAYDEN FAMILY PHARMACY, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 424210
Sponsor’s telephone number 2055901100
Plan sponsor’s address 88 WHITE OAK TRAIL, WARRIOR, AL, 35180

Signature of
Role Plan administrator
Date 2015-09-03
Name of individual signing JENNIFER METCALF

Agent

Name Role
CULWELL, JAMES EDWARD Agent

Incorporator

Name Role
CULWELL, JAMES EDWARD Incorporator
CULWELL, JENNIFER SHIPP Incorporator

Related by officers

No related officers

Related by address

WARRIOR, AL

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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