Covered Entity Details

CH04334AB CareConnect Health, Inc. (Terminated) - information as of 6/26/2025 12:23:54 AM

Main Details

Name

CareConnect Health, Inc.

Subdivision Name

CareConnect School Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017800

340B ID

CH04334AB

Grant Number

H80CS00393

Additional Details

Current Program Status

Terminated

Registration Date

10/7/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/17/2016

Last Recertification Date

2/3/2021

Termination Date
Termination Reason

1/1/2022
Site closure

Contacts

Authorizing Official

CareConnect Health, Inc.
Ajay Gehlot, CEO
(229) 273-8881

Primary Contact

CareConnect Health, Inc.
Lauren Halstead, Operations Manager
(229) 273-8881 Ext: 413

Addresses

Street Address

56 MCDOWELL STREET
BUTLER, GA 31006-5337

Billing Address

CareConnect Health, Inc.
510 Alston Street
Suite B
Richland, GA 31825

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH043340	Active	BPS-H80-004701	CareConnect Health, Inc.	CareConnect Family Practice and Pediatrics	510 Alston Street	Richland	GA
CH04334A	Terminated	BPS-H80-000310	CareConnect Health, Inc.	Plains Medical Center	107 Main St	Plains	GA
CH04334AA	Active	BPS-H80-017821	CareConnect Health, Inc.	Pediatric Urgent Care	1007 E 16th Avenue	Cordele	GA
CH04334AB	Terminated	BPS-H80-017800	CareConnect Health, Inc.	CareConnect School Clinic	56 MCDOWELL STREET	BUTLER	GA
CH04334AC	Active	BPS-H80-010358	CareConnect Health, Inc.	CareConnect Family Dentistry	101 Mayo St	Americus	GA
CH04334AD	Active	BPS-H80-018913	CareConnect Health, Inc.	New Hope Clinic	215 E 13TH AVE	CORDELE	GA
CH04334AE	Active	BPS-H80-019397	CareConnect Health, Inc.	CareConnect Urgent Care	822 South Hill Street	Griffin	GA
CH04334AF	Active	BPS-H80-018996	CareConnect Health, Inc.	CareConnect Family Practice and Pediatrics	317 E Washington Avenue	Ashburn	GA
CH04334AG	Active	BPS-H80-018995	CareConnect Health, Inc.	CareConnect Convenient Care	277 Perry PKWY	Perry	GA
CH04334AH	Active	BPS-H80-019554	CareConnect Health, Inc.	CareConnect Convenient Care	1909 US HWY 82 W	TIFTON	GA
CH04334AJ	Terminated	BPS-H80-020813	CareConnect Health, Inc.	CareConnect School Clinic	705 Hudson Ave	Ashburn	GA
CH04334AK	Terminated	BPS-H80-019696	CareConnect Health, Inc.	CareConnect Clinic	185 Pecan Street	Shellman	GA
CH04334AL	Active	BPS-H80-020870	CareConnect Health, Inc.	CareConnect Pediatrics	110 E 13th AVENUE	CORDELE	GA
CH04334AM	Active	BPS-H80-021569	CareConnect Health, Inc.	CareConnect Convenient Care	209 N Camellia Blvd	Fort Valley	GA
CH04334AN	Active	BPS-H80-022045	CareConnect Health, Inc.	Pediatric Convenient Care	1909 US Highway 82 W	Tifton	GA
CH04334AP	Active	BPS-H80-030483	CareConnect Health, Inc.	CareConnect Pediatrics	760 26th Avenue SE	Moultrie	GA
CH04334AQ	Active	BPS-H80-024801	CareConnect Health, Inc.	CareConnect Family Practice	9 West Main St	Alamo	GA
CH04334AR	Terminated	BPS-H80-027037	CareConnect Health, Inc.	CareConnect School Clinic	360 GA Highway 26	Cusseta	GA
CH04334AS	Active	BPS-H80-030637	CareConnect Health, Inc.	CareConnect OBGYN	412 East 4th Avenue	Cordele	GA
CH04334AT	Active	BPS-H80-027883	CareConnect Health, Inc.	CareConnect Convenient Care	1424 N Expressway	Griffin	GA
CH04334AU	Active	BPS-H80-031111	CareConnect Health, Inc.	CareConnect Family Practice	254 Wright Avenue	Roberta	GA
CH04334AV	Active	BPS-H80-030204	CareConnect Health, Inc.	CareConnect Convenient Care	130 N Lee St	Forsyth	GA
CH04334AW	Active	BPS-H80-030205	CareConnect Health, Inc.	CareConnect Dental Van 1	414 S Frontage Rd LOT 53	Forsyth	GA
CH04334AX	Active	BPS-H80-031460	CareConnect Health, Inc.	CareConnect Convenient Care	125 McDonald Avenue	Cuthbert	GA
CH04334AY	Active	BPS-H80-033496	CareConnect Health, Inc.	CareConnect Family Practice	112 West 6th Avenue UNIT B	Buena Vista	GA
CH04334AZ	Active	BPS-H80-032416	CareConnect Health, Inc.	CareConnect Convenient Care	771 Roundtree Dr SW Ste A	Dawson	GA
CH04334B	Active	BPS-H80-008489	CareConnect Health, Inc.	CareConnect Family Practice	23 Old School Rd	Georgetown	GA
CH04334BA	Active	BPS-H80-034334	CareConnect Health, Inc.	New Hope Clinic	206 E Lamar St	Americus	GA
CH04334BB	Active	BPS-H80-034333	CareConnect Health, Inc.	Pediatric Convenient Care	1114 GA HWY 96	Kathleen	GA
CH04334BC	Active	BPS-H80-035208	CARECONNECT HEALTH INC	CareConnect Convenient Care	259 Broad St	Hawkinsville	GA
CH04334BD	Active	BPS-H80-036055	CARECONNECT HEALTH INC	Pediatric Convenient Care	1205 US Hwy 19 S	Leesburg	GA
CH04334BE	Active	BPS-H80-033787	CARECONNECT HEALTH, INC.	CareConnect Urgent Care	711 E 16th Ave	Cordele	GA
CH04334BF	Active	BPS-H80-037658	CARECONNECT HEALTH, INC.	CareConnect Family Practice	6011 Watson Blvd STE 380	Byron	GA
CH04334BG	Active	BPS-H80-038362	CARECONNECT HEALTH, INC.	CareConnect Family Medicine	602 E 16th AVE STE A&B	Cordele	GA
CH04334BH	Active	BPS-H80-038951	CARECONNECT HEALTH, INC.	CareConnect Convenient Care	6021 Watson Blvd	Byron	GA
CH04334C	Active	BPS-H80-011083	CareConnect Health, Inc.	CareConnect Family Practice	298 Hwy 520	Cusseta	GA
CH04334D	Active	BPS-H80-014038	CareConnect Health, Inc.	CareConnect Family Practice	205 Rees ST	Americus	GA
CH04334E	Active	BPS-H80-005408	CareConnect Health, Inc.	CareConnect Family Practice and Pediatrics	636 2nd Ave	Rochelle	GA
CH04334F	Terminated	BPS-H80-012758	CareConnect Health, Inc.	Eastman Medical Center	1111 Griffin Avenue, Suite A	Eastman	GA
CH04334G	Terminated	BPS-H80-009315	CareConnect Health, Inc.	CareConnect Urgent Care	602 E 16th Ave	Cordele	GA
CH04334H	Active	BPS-H80-011053	CareConnect Health, Inc.	Americus Urgent Care	618 E Lamar St	Americus	GA
CH04334J	Active	BPS-H80-012759	CareConnect Health, Inc.	CareConnect Family Practice and Pediatrics	817 Griffin Ave	Eastman	GA
CH04334K	Active	BPS-H80-010375	CareConnect Health, Inc.	CareConnect Pediatrics	609 E Lamar St	Americus	GA
CH04334L	Active	BPS-H80-008747	CareConnect Health, Inc.	CareConnect Family Practice	712 N 7th St	Cordele	GA
CH04334M	Active	BPS-H80-017921	CareConnect Health, Inc.	CareConnect Family Practice	109 South Third Street	Cochran	GA
CH04334N	Active	BPS-H80-010871	CareConnect Health, Inc.	CareConnect Urgent Care	1805 Tift Avenue North	Tifton	GA
CH04334P	Active	BPS-H80-018212	CareConnect Health, Inc.	Pediatric Convenient Care	6005 Watson Blvd	Byron	GA
CH04334Q	Active	BPS-H80-011789	CareConnect Health, Inc.	CareConnect Family Practice	300 Medical Court	Oglethorpe	GA
CH04334R	Active	BPS-H80-012912	CareConnect Health, Inc.	CareConnect Family Practice	80 West Main Street	Butler	GA
CH04334S	Active	BPS-H80-017822	CareConnect Health, Inc.	Americus OBGYN	603 E Lamar St	AMERICUS	GA
CH04334T	Active	BPS-H80-019250	CareConnect Health, Inc.	CareConnect Pediatrics	506-C Spaulding Road	Montezuma	GA
CH04334U	Active	BPS-H80-015789	CareConnect Health, Inc.	CareConnect Convenient Care	101 Deluxe Circle	Thomaston	GA
CH04334V	Active	BPS-H80-018275	CareConnect Health, Inc.	CareConnect Convenient Care	41 East Oglethorpe Street	Ellaville	GA
CH04334W	Terminated	BPS-H80-015191	CareConnect Health, Inc.	CareConnect School Clinic	140 Merrell Street	Cusseta	GA
CH04334X	Active	BPS-H80-029934	CareConnect Health, Inc.	CareConnect Urgent Care	358 Veterans Pkwy N	Moultrie	GA
CH04334Y	Terminated	BPS-H80-017463	CareConnect Health, Inc.	CareConnect OBGYN	222 Perry Hwy, Professional Building B	Hawkinsville	GA
CH04334Z	Terminated	BPS-H80-017823	CareConnect Health, Inc.	CareConnect School Clinic	218 East Main Street	Butler	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH04334F	ABBEVILLE DISCOUNT DRUGS	201 MAIN ST W		ABBEVILLE	GA	31001	09/09/2011	05/05/2016
CH043340	ADAMS FAMILY PHARMACY, INC	ADAMS FAMILY PHARMACY	6381 HAMILTON ST	PRESTON	GA	31824-3182	10/01/2014	10/01/2018
CH043340	ADP HOLDINGS LLC	ROBINS PHARMACY	608 S HOUSTON LAKE RD STE 100	WARNER ROBINS	GA	31088	01/01/2025
CH043340	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2014	01/31/2025
CH043340	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2019
CH043340	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2025
CH043340	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH043340	BECKY'S DRUGSTORE, LLC	128 N BROAD ST	P O BOX 560	BUENA VISTA	GA	31803-2006	01/01/2025
CH043340	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	10/01/2018	11/25/2019
CH043340	BRIOVARX OF MASSACHUSETTS, LLC	D/B/A BRIOVARX	BLDG 2 - UNIT A 145 BODWELL STREET	AVON	MA	02322	10/01/2018	11/25/2019
CH043340	CCN AMERICA LP D/B/A COORDINATED CARE NE	110 E 13TH AVE STE A		CORDELE	GA	31015	01/01/2020	05/25/2021
CH04334AL	CCN AMERICA LP D/B/A COORDINATED CARE NE	110 E 13TH AVE STE A		CORDELE	GA	31015	01/01/2020
CH043340	CHANCY DRUGS MOULTRIE LLC	101 N MAIN ST		MOULTRIE	GA	31768	10/01/2019
CH043340	CLINIC DRUG STORE	1001 E FORSYTH ST	PO BOX 445	AMERICUS	GA	31709	07/01/2017
CH04334D	CLINIC DRUG STORE	1001 E FORSYTH ST	PO BOX 445	AMERICUS	GA	31709	02/02/2012	05/05/2016
CH04334H	CLINIC DRUG STORE	1001 E FORSYTH ST	PO BOX 445	AMERICUS	GA	31709	09/22/2011	05/05/2016
CH04334AL	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	10/01/2017
CH043340	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	01/01/2018	09/30/2022
CH043340	CRYSTAL PHARMACY LLC	705 S MAIN ST		MOULTRIE	GA	31768-5432	01/01/2017	01/01/2017
CH043340	CRYSTAL PHARMACY LLC	705 S MAIN ST		MOULTRIE	GA	31768-5432	07/01/2018
CH043340	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	07/01/2024	04/24/2025
CH043340	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/01/2024	04/24/2025
CH043340	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/01/2017	11/27/2019
CH043340	DOCTORS PHARMACY	611 E LAMAR ST STE B		AMERICUS	GA	31709-3744	01/01/2014
CH04334D	DOCTORS PHARMACY	611 E LAMAR ST STE B		AMERICUS	GA	31709-3744	10/26/2011
CH043340	DOCTORS PHARMACY	116 WALNUT ST		MONTEZUMA	GA	31063-1903	01/01/2020
CH043340	DOGWOOD PHARMACY	1909 US HIGHWAY 82 W STE 11		TIFTON	GA	31793-8213	07/01/2018
CH043340	EASTMAN DRUGS INC	1221 PLAZA AVE STE B		EASTMAN	GA	31023-9011	01/01/2014
CH04334F	EASTMAN DRUGS INC	1221 PLAZA AVE STE B		EASTMAN	GA	31023-9011	09/09/2011	07/01/2018
CH043340	ECKERD CORPORATION	RITE AID #11858	1442 EAST LAMAR STREET	AMERICUS	GA	31709	01/01/2014	12/21/2017
CH043340	ECKERD CORPORATION	RITE AID #11785	708 NORTH CHURCH STREET	THOMASTON	GA	30286	10/01/2016	12/21/2017
CH043340	FIVE POINTS PHARMACY	115 COMMERCIAL HEIGHTS		FORT VALLEY	GA	31030	07/01/2019	06/19/2019
CH043340	FLINT RIVER PHARMACY LLC	506-C SPAULDING ROAD		MONTEZUMA	GA	31063	01/01/2016	04/12/2018
CH043340	FLINT RIVER PHARMACY LLC	506-C SPAULDING ROAD		MONTEZUMA	GA	31063	04/12/2018	03/29/2019
CH043340	FOOD LION PHARMACY #2222	107 PRINCE STREET		AMERICUS	GA	31709	10/01/2023
CH043340	FORT VALLEY DRUG CO. LLC	FIVE POINTS PHARMACY	217 N CAMELLIA BLVD	FORT VALLEY	GA	31030	06/19/2019
CH043340	FRED'S PHARMACY #2321	201 WALNUT STREET		MONTEZUMA	GA	31063	10/01/2017	08/22/2019
CH043340	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04267	214 EAST 16TH AVE.	CORDELE	GA	31015	07/01/2016	07/01/2016
CH043340	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05673	501 SPAULDING ROAD	MONTEZUMA	GA	31063	07/01/2016	03/11/2020
CH043340	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04672	1036 E. FORSYTH ST.	AMERICUS	GA	31709	07/01/2016	03/11/2020
CH043340	HARCO INC.	RITE AID #4606	130 SOUTH EUFAULA AVENUE	EUFAULA	AL	36027	01/01/2014	12/21/2017
CH043340	HARVEYS SUPERMARKET #1656	SAMSON MERGER SUB, LLC	120 W OAK ST	MC RAE HELENA	GA	31055-4335	04/01/2022	11/27/2023
CH043340	J&R96 HOLDINGS LLC	DBA: BONAIRE PHARMACY	810 SR 96 SUITE 1800	WARNER ROBINS	GA	31088	01/01/2025
CH043340	KROGER DRUGSTORE #407	1367 SAM NUNN BLVD		PERRY	GA	31069	10/01/2023
CH043340	KROGER PHARMACY #641	774 HIGHWAY 96		BONAIRE	GA	31005	10/01/2023
CH043340	KROGER PHARMACY #696	3094 WATSON BLVD		WARNER ROBINS	GA	31088	10/01/2023
CH043340	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2019
CH043340	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334A	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334B	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334C	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334D	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334E	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334F	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334G	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334H	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334K	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334J	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334L	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334M	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334N	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334P	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH04334Q	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	10/16/2015
CH043340	MEDICAL CENTER PRESCRIPTION	MEDICAL CENTER PRESCRIPTION SHOP	710 MEDICAL CENTER DR	EASTMAN	GA	31023-6736	01/01/2014	05/05/2016
CH04334F	MEDICAL CENTER PRESCRIPTION	MEDICAL CENTER PRESCRIPTION SHOP	710 MEDICAL CENTER DR	EASTMAN	GA	31023-6736	09/09/2011	05/05/2016
CH043340	MEDICINE STOP LLC	D/B/A MEDICINE STOP II	212 N DOOLY ST	MONTEZUMA	GA	31063	07/01/2024
CH04334Q	MONTEZUMA DRUG COMPANY		112 SOUTH DOOLY STREET	MONTEZUMA	GA	31063	07/01/2013	07/21/2016
CH043340	MONTEZUMA DRUG COMPANY	212 N DOOLY ST		MONTEZUMA	GA	31063	01/01/2021	08/01/2023
CH043340	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/01/2018	11/25/2019
CH043340	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2018	11/25/2019
CH043340	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2018	11/25/2019
CH043340	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	10/01/2018	11/25/2019
CH043340	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH043340	PLAINS PHARMACY INC	103 MAIN STREET .	P.O. BOX 160	PLAINS	GA	31780	01/01/2014
CH043340	PUBLIX SUPER MARKETS, INC	PUBLIX PHARMACY #1008	1114 HIGHWAY 96	KATHLEEN	GA	31047	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1291	6015 WATSON BLVD.	BYRON	GA	31008	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1422	620 VIRGINIA AVE. NORTH	TIFTON	GA	31794	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1349	1212 US HIGHWAY 19 SOUTH	LEESBURG	GA	31763	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1233	275 PERRY PKWY	PERRY	GA	31069	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1622	510 GA HWY 247 SOUTH	BONAIRE	GA	31005	10/01/2023
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	10/01/2024
CH043340	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	10/01/2024
CH04334F	RHINE DRUG COMPANY	119 FIRST STREET		RHINE	GA	31077	09/09/2011	07/21/2016
CH043340	RHINE DRUG COMPANY	119 FIRST STREET		RHINE	GA	31077	01/01/2021
CH04334E	ROCHELLE DRUG COMPANY	600 SECOND AVENUE		ROCHELLE	GA	31079	09/09/2011	05/05/2016
CH043340	SAMSON MERGER SUB, LLC	HARVEYS SUPERMARKET #1627	1011 E. 16TH AVENUE	CORDELE	GA	31015-1539	07/01/2016	11/12/2023
CH04334B	SHELLMAN DRUG CO	75 WEST RAILROAD STREET	PO BOX 420	SHELLMAN	GA	39886	09/22/2011	05/05/2016
CH043340	SMITH'S PHARMACY	BAZEMORE, ROBERT JOHNNY PRES	10 N POPLAR ST P.O. BOX 546	BUTLER	GA	31006	07/01/2019
CH043340	SOUTH GEORGIA DRUG COMPANY	DBA- FRIENDLY CITY PHARMACY	1202 US HIGHWAY 41 N	TIFTON	GA	31794-3202	07/01/2021
CH043340	THE BLAND CO, INC	D/B/A U SAVE IT PHARMACY - GRIFFIN	222 W POPLAR ST D B A U SAVE IT PHARMACY GRIFFIN	GRIFFIN	GA	30224-3033	01/01/2021
CH043340	U SAVE IT PHARMACY #21	438 CABINESS RD STE C		FORSYTH	GA	31029	01/01/2021
CH043340	U SAVE IT PHARMACY - CLAXTON HOBBS	131 W TAYLOR ST		GRIFFIN	GA	30223	07/01/2023
CH043340	U SAVE IT PHARMACY INC. #5	676 ALSTON ST		RICHLAND	GA	31825-6043	09/21/2011
CH043340	U SAVE IT PHARMACY INC. #8	101 W WHITE RD		BYRON	GA	31008	01/01/2021
CH043340	U SAVE IT PHARMACY NORTHWEST	2624 MEREDYTH DR		ALBANY	GA	31707	07/01/2023
CH043340	U SAVE IT PHARMACY SOUTH ALBANY	1310 NEWTON RD		ALBANY	GA	31701-3480	07/01/2023
CH043340	U SAVE IT PHARMACY, INC. #14	609 BLUEBIRD BLVD		FORT VALLEY	GA	31030	01/01/2021
CH043340	U-SAVE IT PHARMACY-LEESBURG	100 TABATHA ST		LEESBURG	GA	31763	07/01/2023
CH043340	U-SAVE-IT PHARMACY	405 4TH AVE EAST		CORDELE	GA	31015	01/01/2014
CH04334L	U-SAVE-IT PHARMACY	405 4TH AVE EAST		CORDELE	GA	31015	09/21/2011
CH043340	U-SAVE-IT PHARMACY #3	1315 DAWSON ROAD	P.O. BOX 72148	ALBANY	GA	31708	07/01/2023
CH043340	U-SAVE-IT PHARMACY, INC. #1	400 N JEFFERSON ST		ALBANY	GA	31701	07/01/2023
CH043340	U-SAVE-IT PHARMACY-PALMYRA	2112 PALMYRA RD		ALBANY	GA	31701	07/01/2023
CH043340	UNIVERSAL PHARMACEUTICS	DOCTOR'S PHARMACY	298 MEDICAL COURT PO BOX 322	OGLETHORPE	GA	31068	01/01/2014	05/31/2017
CH04334H	UNIVERSAL PHARMACEUTICS	DOCTOR'S PHARMACY	298 MEDICAL COURT PO BOX 322	OGLETHORPE	GA	31068	04/01/2013
CH043340	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017	07/01/2022
CH043340	WAL-MART PHARMACY #10-7245	1102 E. FRANKLIN		SYLVESTER	GA	31791	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY #10-7246	366 HWY 26 EAST		COCHRAN	GA	31014	10/01/2018	07/01/2022
CH043340	WAL-MART PHARMACY 10-0520	440 ALANTA HIGHWAY, N.W.		WINDER	GA	30680	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-0686	120 BENJAMIN H. HILL DR SW		FITZGERALD	GA	31750	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-0758	1711 E LAMAR ST STE F		AMERICUS	GA	31709	07/01/2014	07/01/2022
CH04334G	WAL-MART PHARMACY 10-0758	1711 E LAMAR ST STE F		AMERICUS	GA	31709	04/01/2014	01/01/2024
CH043340	WAL-MART PHARMACY 10-0907	180 NORTH LEE ST		FORSYTH	GA	31029	07/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1006	1215 EAST 16TH AVENUE		CORDELE	GA	31015	07/01/2014	07/01/2022
CH04334G	WAL-MART PHARMACY 10-1006	1215 EAST 16TH AVENUE		CORDELE	GA	31015	04/01/2014	01/01/2024
CH043340	WAL-MART PHARMACY 10-1018	1099 INDIAN DR.		EASTMAN	GA	31023	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1072	1830 US HIGHWAY 82 W		TIFTON	GA	31793	07/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1112	855 N. CHURCH STREET		THOMASTON	GA	30286	07/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1338	3515 VICTORY DRIVE		COLUMBUS	GA	31903	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-1638	3176 S EUFAULA AVE		EUFAULA	AL	36027	10/01/2018	07/01/2022
CH043340	WAL-MART PHARMACY 10-2733	1009 ST. PATRICKS DRIVE		PERRY	GA	31069	10/01/2018	07/01/2022
CH043340	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-3750	502 BOOTH ROAD		WARNER ROBINS(S)	GA	31088	10/01/2021	07/01/2022
CH043340	WAL-MART PHARMACY 10-4283	2801 AIRPORT THRUWAY		COLUMBUS	GA	31909	01/01/2022	07/01/2022
CH043340	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017	07/01/2022
CH043340	WALGREEN CO	DBA: WALGREENS #10833	615 LOVE AVE	TIFTON	GA	31794	09/01/2011
CH043340	WALGREEN CO	DBA: WALGREENS #12319	126 BROAD STREET	HAWKINSVILLE	GA	31036	09/01/2011
CH043340	WALGREEN CO	DBA: WALGREENS #11106	733 E FORSYTH ST	AMERICUS	GA	31709-3718	09/01/2011
CH043340	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	01/01/2013
CH043340	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	01/01/2013
CH043340	WALGREEN CO	DBA: WALGREENS #11490	634 N. CHURCH STREET	THOMASTON	GA	30286-3612	07/01/2016
CH043340	WALGREEN CO	DBA: WALGREENS #10632	1602 N EXPRESSWAY	GRIFFIN	GA	30223-1269	04/01/2020
CH043340	WALGREEN CO.	DBA: WALGREENS #12263	102 S. 2ND STREET	COCHRAN	GA	31014	09/01/2011	08/24/2016
CH043340	WALGREEN CO.	DBA: WALGREENS #11704	5301 SUMMERVILLE RD	PHENIX CITY	AL	36867	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06328	2510 WYNNTON ROAD	COLUMBUS	GA	31906	09/01/2011	04/08/2024
CH043340	WALGREEN CO.	DBA: WALGREENS # 09849	1024 E 16TH AVE	CORDELE	GA	31015-1595	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06326	3700 MACON ROAD	COLUMBUS	GA	31907-2248	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06327	4808 BUENA VISTA ROAD	COLUMBUS	GA	31907	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06373	5707 VETERANS PKWY	COLUMBUS	GA	31904	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06483	2515 CRAWFORD ROAD	PHENIX CITY	AL	36867	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS #12754	7869 VETERANS PKWY	COLUMBUS	GA	31909	09/01/2011
CH043340	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	01/01/2013	02/17/2025
CH043340	WALGREEN CO.	DBA: WALGREENS # 09643	102 RUSSELL PKWY	WARNER ROBINS	GA	31088-6165	07/01/2013
CH043340	WALGREEN CO.	DBA: WALGREENS #12756	2025 FIRST AVENUE SE	MOULTRIE	GA	31788	01/01/2017
CH043340	WALGREEN CO.	DBA: WALGREENS #11793	1100 BALL STREET	PERRY	GA	31069	04/01/2017	02/27/2025
CH04334AL	WALGREEN CO.	DBA WALGREENS #15913	2200A E. OGLETHORPE BLVD.	ALBANY	GA	31705	01/01/2018
CH043340	WALGREEN CO.	DBA WALGREENS #15913	2200A E. OGLETHORPE BLVD.	ALBANY	GA	31705	01/01/2018	11/11/2021
CH043340	WALGREEN CO.	WALGREENS #19668	130 S EUFAULA AVE	EUFAULA	AL	36027-2026	01/05/2018
CH043340	WALGREEN CO.	RITE AID #11858	1442 E LAMAR ST	AMERICUS	GA	31709	04/13/2018	10/18/2018
CH043340	WALGREEN CO.	RITE AID #11785	708 N CHURCH ST	THOMASTON	GA	30286	04/13/2018	10/18/2018
CH043340	WALGREEN CO.	DBA: WALGREENS #19322	405 S HILL ST	GRIFFIN	GA	30224	01/01/2019
CH043340	WALGREEN CO.	WALGREENS #18188	1655 ZEBULON RD	GRIFFIN	GA	30224	01/01/2019
CH043340	WALGREEN CO.	DBA: WALGREENS #19839	650 E WASHINGTON AVE	ASHBURN	GA	31714	01/01/2019	02/25/2025
CH043340	WALGREEN CO.	WALGREENS #19828	305 W MAIN ST	MANCHESTER	GA	31816	04/01/2019
CH043340	WALGREEN CO.	WALGREENS #17418	506 W 4TH ST	ADEL	GA	31620	01/01/2020
CH043340	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15304	1874 PIEDMONT AVE NE STE 100A	ATLANTA	GA	30324	04/01/2022
CH043340	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21146	565 PEACHTREE ST NE STE B	ATLANTA	GA	30308	01/01/2023
CH043340	WALMART PHARMACY #10-0920	3009 RUSSELL PARKWAY		WARNER ROBINS	GA	31088	10/01/2021	07/01/2022
CH043340	WALMART PHARMACY #10-5198	1810 TIFT AVE N		TIFTON	GA	31794	10/01/2018	07/01/2022
CH043340	WALMART PHARMACY #10-5907	4909 BUENA VISTA ROAD		COLUMBUS	GA	31907-7271	10/01/2021	07/01/2022
CH043340	WHEELER COUNTY DRUG COMPANY	15 E SECOND AVE	PO BOX 247	GLENWOOD	GA	30428	07/01/2019	10/31/2023
CH043340	WINN DIXIE PHARMACY # 439	6770 VETERANS PARKWAY		COLUMBUS	GA	31909	04/01/2022	09/14/2023
CH043340	WINN-DIXIE PHARMACY	DBA WINN-DIXIE PHARMACY #478	1055 S EUFAULA AVENUE	EUFAULA	AL	36027	07/01/2016	09/13/2023
CH043340	WINN-DIXIE PHARMACY #443	4231 MACON ROAD		COLUMBUS	GA	31907	04/01/2022	10/18/2023
CH043340	WINN-DIXIE PHARMACY #482		1100 HUNT AVENUE	COLUMBUS	GA	31907	04/01/2017	04/01/2017
CH043340	WINN-DIXIE STORES, INC.	HARVEYS SUPERMARKET #1697	1208 CRAWFORD ST	AMERICUS	GA	31709	07/01/2016	11/14/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881-35	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881-413	1/29/2024 9:38 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/18/2021 12:00:00 AM	10/12/2021 11:43 AM
Details	State	Update	Termination Request	Active	To Be Terminated	10/12/2021 11:43 AM
Terminations	Termination Date	Update	Termination Request		1/1/2022 12:00:00 AM	10/12/2021 11:43 AM
Terminations	Termination Effective Date	Update	Termination Request		1/18/2021 12:00:00 AM	10/12/2021 11:43 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	10/12/2021 11:43 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 2:23:38 PM	2/3/2021 2:48:05 PM	2/3/2021 2:48 PM
Details	Last Recertification Date	Update	Recertification	2/1/2019 10:56:48 AM	2/3/2020 2:23:38 PM	2/3/2020 2:23 PM
Details	Last Recertification Date	Update	Recertification	2/8/2018 9:36:29 AM	2/1/2019 10:56:48 AM	2/1/2019 10:56 AM
Contacts	Authorizing Official	Update	Change Request	Gehlot, Ajay CEO CareConnect Health, Inc. 2292738881	Gehlot, Ajay CEO CareConnect Health, Inc. 2292738881	8/13/2018 1:53 PM
Contacts	Primary Contact	Update	Change Request	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881-35	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881-35	8/13/2018 10:34 AM
Contacts	Primary Contact	Update	New Registration	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881-35	4/9/2018 4:11 PM
Details	Entity Subname	Update	Change Request	Taylor County Primary School Clinic	CareConnect School Clinic	3/30/2018 8:05 AM
Addresses	Billing Address	Update	Change Request	CareConnect Health, Inc. 220 Alston Street Richland, GA 31825	CareConnect Health, Inc. 510 Alston Street Suite B Richland, GA 31825	3/22/2018 12:56 PM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/8/2018 9:36:29 AM	2/8/2018 9:36 AM
Addresses	Billing Address	Update	Change Request	Southwest Georgia Health Care, Inc 220 Alston Street Richland, GA 31825	CareConnect Health, Inc. 220 Alston Street Richland, GA 31825	11/29/2017 1:10 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		11/29/2017 1:10 PM
Details	Entity Name	Update	Change Request	SOUTHWEST GEORGIA HEALTH CARE, INC	CareConnect Health, Inc.	11/29/2017 1:10 PM
Contacts	Authorizing Official	Update	Profile Change Request	Gehlot, Ajay CEO Southwest Georgia Health Care, Inc. 2292738881	Gehlot, Ajay CEO CareConnect Health, Inc. 2292738881	11/2/2017 4:32 PM
Contacts	Signed By	Update	Profile Change Request	Gehlot, Ajay CEO Southwest Georgia Health Care, Inc. 2292738881	Gehlot, Ajay CEO CareConnect Health, Inc. 2292738881	11/2/2017 4:32 PM
Contacts	Primary Contact	Update	Profile Change Request	Halstead, Lauren Operations Manager Southwest Georgia Health Care, Inc. 2292738881	Halstead, Lauren Operations Manager CareConnect Health, Inc. 2292738881	11/1/2017 1:37 PM
Contacts	Primary Contact	Update		Halstead, Lauren Operations Manager 2292738881	Halstead, Lauren Operations Manager Southwest Georgia Health Care, Inc. 2292738881	9/21/2017 1:51 PM
Contacts	Authorizing Official	Update		Gehlot, Ajay CEO 2292738881	Gehlot, Ajay CEO Southwest Georgia Health Care, Inc. 2292738881	9/21/2017 1:36 PM
Contacts	Signed By	Update		Gehlot, Ajay CEO 2292738881	Gehlot, Ajay CEO Southwest Georgia Health Care, Inc. 2292738881	9/21/2017 1:36 PM
Contacts	Primary Contact	Update		Partain, Helen Prescription Program Coordinator 2292738881	Halstead, Lauren Operations Manager 2292738881	8/11/2017 9:44 AM
Contacts	Authorizing Official	Insert			Gehlot, Ajay CEO 2292738881	8/11/2017 9:44 AM
Contacts	Signed By	Insert			Gehlot, Ajay CEO 2292738881	8/11/2017 9:44 AM
Addresses	Main Address	Insert			56 MCDOWELL STREET BUTLER, GA 31006-5337	2/8/2017 4:45 PM
Details	Last Recertification Date	Update			2/8/2017 12:00:00 AM	2/8/2017 4:45 PM
Contacts	Primary Contact	Insert			Partain, Helen Prescription Program Coordinator 2292738881	1/22/2017 3:11 PM
Addresses	Billing Address	Insert			Southwest Georgia Health Care, Inc 220 Alston Street Richland, GA 31825	12/19/2016 5:53 PM
Details	340B ID	Update		CH04334ZAB	CH04334AB	12/19/2016 5:53 PM
Dates	Participating Approval Date	Update			11/17/2016 12:00:00 AM	11/17/2016 6:55 PM
Details	State	Update		Pending	Active	11/17/2016 6:55 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/17/2016 6:55 PM
Details	340B ID	Update		ONLINE_REG_72621	CH04334ZAB	11/17/2016 9:20 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_72621	10/7/2016 10:17 AM
Details	Last Recertification Date	Insert				10/7/2016 10:17 AM
Details	Grant Number	Insert			H80CS00393	10/7/2016 10:17 AM
Details	340B ID	Insert			ONLINE_REG	10/7/2016 10:17 AM
Details	Is Authorizing Official EHB Data	Insert			False	10/7/2016 10:17 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2016 10:17 AM
Details	Medicare Provider Number	Insert				10/7/2016 10:17 AM
Details	Entity Name	Insert			SOUTHWEST GEORGIA HEALTH CARE, INC	10/7/2016 10:17 AM
Details	Program Code	Insert			CH	10/7/2016 10:17 AM
Details	Entity Subname	Insert			Taylor County Primary School Clinic	10/7/2016 10:17 AM
Dates	Participating Approval Date	Insert				10/7/2016 10:17 AM
Details	State	Insert			Pending	10/7/2016 10:17 AM
Dates	Registration Date	Insert			10/7/2016 12:00:00 AM	10/7/2016 10:17 AM
Dates	Signed By Date	Insert			10/7/2016 12:00:00 AM	10/7/2016 10:17 AM
Dates	Start Date	Insert				10/7/2016 10:17 AM
Terminations	Termination Comments	Insert				10/7/2016 10:17 AM
Terminations	Termination Date	Insert				10/7/2016 10:17 AM
Terminations	Termination Effective Date	Insert				10/7/2016 10:17 AM
Terminations	Termination Reason	Insert				10/7/2016 10:17 AM

340B Drug Pricing Program Database