| Name: | Chase Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 09 Jun 2005 (19 years ago) (Companies founded in June 2005) |
| Entity Number: | 000-241-902 |
| Register Number: | 000241902 |
| ZIP code: | 35761 (Companies in Madison, 35761) |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | BROWNSBORO, AL |
| Registered Office Street Address: | 3216 HURRICANE RDNEW MARKET, AL 35761 |
| Authorized Capital: | $100 |
Activities
OWN/OPERATE/MANAGE PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871639484 | 2007-01-30 | 2018-09-20 | 2700 WINCHESTER RD NE STE B, HUNTSVILLE, AL, 358119230, US | 2700 WINCHESTER RD NE STE B, HUNTSVILLE, AL, 358119230, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-851-1345 |
| Fax | 2568511347 |
Authorized person
| Name | RICK SANSOM |
| Role | PRESIDENT AND PHCIST |
| Phone | 2568511345 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 112719 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 1995717 |
| Issuer | MEDICAID |
| Number | 100003664 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHASE PHARMACY, INC. 401(K) P/S PLAN | 2016 | 611489133 | 2017-05-10 | CHASE PHARMACY, INC. | 6 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 611489133 |
| Plan administrator’s name | CHASE PHARMACY, INC. |
| Plan administrator’s address | 1762 WINCHESTER RD NE, HUNTSVILLE, AL, 35811 |
| Administrator’s telephone number | 2568295421 |
Signature of
| Role | Plan administrator |
| Date | 2017-05-10 |
| Name of individual signing | RICKY SANSOM |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 2568295421 |
| Plan sponsor’s address | 1762 WINCHESTER RD NE, HUNTSVILLE, AL, 35811 |
Plan administrator’s name and address
| Administrator’s EIN | 611489133 |
| Plan administrator’s name | CHASE PHARMACY, INC. |
| Plan administrator’s address | 1762 WINCHESTER RD NE, HUNTSVILLE, AL, 35811 |
| Administrator’s telephone number | 2568295421 |
Signature of
| Role | Plan administrator |
| Date | 2016-07-19 |
| Name of individual signing | YVONNE TAFOYA |
| Name | Role | Address |
|---|---|---|
| SANSOM, RICKY T | Agent | 3216 HURRICANE ROADNEW MARKET, AL 35761 |
| Name | Role | Address |
|---|---|---|
| SANSOM, RICKY T | Incorporator | 3216 HURRICANE ROADNEW MARKET, AL 35761 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
