340B Drug Pricing Program Database


CH04039T Medlink Georgia, Inc (Active) - information as of 5/12/2025 10:10:04 PM

Main Details
Medlink Georgia, Inc
MedLink Commerce
HRSA-Funded Health Center
BPS-H80-036500
CH04039T
H80CS00427


Additional Details
Active
4/12/2018
4/13/2018
4/13/2018
2/11/2025

Contacts

Medlink Georgia, Inc
Dave Ward, CEO
(706) 788-3234

Medlink Georgia, Inc
Dennis Kimbrell, Director of Pharmacy Services
(706) 788-3234 Ext: 2204

Addresses

611 Hospital Rd
Commerce, GA 30529

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
GA003204487A,003167129A,003202598A1245732254,1801262720,1477068526
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH040390ActiveBPS-H80-003904MEDLINK GEORGIA, INC.Medlink Colbert11 CHARLIE MORRIS RD COLBERTGA
CH04039AActiveBPS-H80-002112MEDLINK GEORGIA, INCMEDLINK BOWMAN206 E Church St BowmanGA
CH04039AAActiveBPS-H80-035114Medlink Georgia, IncMedLink Rabun Family Foot Care180 Legacy Pt STE 102 ClaytonGA
CH04039ABActiveBPS-H80-034482Medlink Georgia, IncMedLink Toccoa711 Rose Ln ToccoaGA
CH04039ACActiveBPS-H80-035600MEDLINK GEORGIA INCMedLink Warrior Wellness Center2648 Highway 129 N, ClevelandGA
CH04039ADActiveBPS-H80-035518MEDLINK GEORGIA INCMedLink Cleveland Family Foot Care2109 Highway 129 S, STE C, ClevelandGA
CH04039AEActiveBPS-H80-036065MEDLINK GEORGIA INCMedLink Rabun Women's Health Center563 Mountain City Rd ClaytonGA
CH04039AFActiveBPS-H80-036607MEDLINK GEORGIA, INC.MedLink Oconee1160 Capital Ave. STE 105, WatkinsvilleGA
CH04039AGActiveBPS-H80-037024MEDLINK GEORGIA, INC.MedLink Athens2000 Prince Ave AthensGA
CH04039AHActiveBPS-H80-038953MEDLINK GEORGIA, INC.MedLink Hawks School Based Health Center2035 Calvary Church Rd GainesvilleGA
CH04039AJActiveBPS-H80-039330MEDLINK GEORGIA, INC.MedLink Coile School Based Health Center110 Old Elberton Rd AthensGA
CH04039AKActiveBPS-H80-039329MEDLINK GEORGIA, INC.MedLink HT Edwards School Based Health Center440 Dearing Ext, Bldg 3 AthensGA
CH04039BActiveBPS-H80-038020MEDLINK GEORGIA, INCMedLink Banks112 Banks Road STE 1 CommerceGA
CH04039CActiveBPS-H80-003403MEDLINK GEORGIA, INCMEDLINK RABUN896 Highway 441 S ClaytonGA
CH04039DActiveBPS-H80-002487MEDLINK GEORGIA, INCMEDLINK HARTWELL63 W. GIBSON ST HARTWELLGA
CH04039EActiveBPS-H80-024492MEDLINK GEORGIA, INCMedLink Gainesville520 Jesse Jewell Pkwy SE GainesvilleGA
CH04039HActiveBPS-H80-014543MEDLINK GEORGIA, INCMEDLINK ROYSTON930 Franklin Springs St ROYSTONGA
CH04039JActiveBPS-H80-001994MEDLINK GEORGIA, INCMEDLINK OGLETHORPE247 Union Point St LexingtonGA
CH04039LActiveBPS-H80-015247MEDLINK GEORGIA, INCMedLink Winder133 W Athens ST WinderGA
CH04039MActiveBPS-H80-013508MEDLINK GEORGIA, INCMedLink Habersham396 Historic Highway 441 N DemorestGA
CH04039NActiveBPS-H80-021314MEDLINK GEORGIA, INCMedLink White17 WHITE ST CLEVELANDGA
CH04039PActiveBPS-H80-036772MEDLINK GEORGIA, INCMedLink Monroe705 Breedlove Dr, Ste 100 MonroeGA
CH04039QActiveBPS-H80-033547MEDLINK GEORGIA, INCMedLink Danielsville306 Courthouse Sq DanielsvilleGA
CH04039RActiveBPS-H80-018749MEDLINK GEORGIA, INCMedLink Winder Women's Health Center137 W Athens St Ste 103 WinderGA
CH04039STerminatedBPS-H80-021314Medlink Georgia, IncMedLink White17 White St ClevelandGA
CH04039TActiveBPS-H80-036500Medlink Georgia, IncMedLink Commerce611 Hospital Rd CommerceGA
CH04039UActiveBPS-H80-022087Medlink Georgia, IncMedLink Rabun North773 N Main St ClaytonGA
CH04039VActiveBPS-H80-034074Medlink Georgia, IncMedLink Lawrenceville980 Lawrenceville Hwy LawrencevilleGA
CH04039WActiveBPS-H80-032036Medlink Georgia, IncMedLink Jefferson2748 Winder Hwy JeffersonGA
CH04039XActiveBPS-H80-033069Medlink Georgia, IncMedLink Suches56 Firewater Ln SuchesGA
CH04039YActiveBPS-H80-034727Medlink Georgia, IncMedLink Hartwell Family Foot Care1087 E Franklin St STE G HartwellGA
CH04039ZActiveBPS-H80-021735Medlink Georgia, IncMedLink Commerce Family Foot Care613 Hospital Rd CommerceGA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH040390ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2019 12/02/2019
CH040390ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2019 12/02/2019
CH040390ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2019  
CH040390ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2019 12/02/2019
CH040390ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2019 12/02/2019
CH040390ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/01/2019 12/02/2019
CH040390AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080807/01/2019  
CH040390AVITA PHARMACY 1046LONG'S DRUGS OF SANDERSVILLE, GEORGIA, I 2140 PEACHTREE RD NW STE 232
ATLANTAGA3030907/01/2023  
CH040390CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2023  
CH040390CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2023  
CH040390CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2023  
CH040390CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2023  
CH040390CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2023  
CH040390CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2023  
CH040390CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2023  
CH040390CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2023  
CH040390CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2023  
CH040390CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2023  
CH040390CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282401/01/2024  
CH040390CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506901/01/2024  
CH040390CLEVELAND DRUG CO INCDBA CLEVELAND DRUG CO 184 W KYTLE ST STE A
CLEVELANDGA3052801/01/2018  
CH040390CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD STE 1400
ST PETERSBURGFL33716-233804/01/2015 07/11/2018
CH040390CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B 		SMYRNAGA30082-525004/01/2015 07/11/2018
CH040390CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2023  
CH040390CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2023  
CH040390CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2023  
CH040390CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2022  
CH040390DIXIE CITY PHARMACYDIXIE CITY PHARMACY 1079 JESSE JEWELL PKWY SW
GAINESVILLEGA30501-305010/01/2013 06/05/2018
CH040390ECKERD CORPORATIONRITE AID #11827 39 EAST MAY STREET, SUITE I
WINDERGA3068010/01/2013 03/01/2018
CH040390ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/01/2019 12/02/2019
CH040390EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/01/2019 12/02/2019
CH040390EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/01/2019  
CH040390EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/01/2019  
CH040390FRED'S PHARMACY # 2129718 ATHENS RD
LEXINGTONGA30648-190701/01/2017 10/16/2019
CH040390FRED'S PHARMACY # 29591567 N. CHEROKEE ROAD
SOCIAL CIRCLEGA3002501/01/2017 05/10/2018
CH040390FRED'S PHARMACY #139415 COLBERT BUSINESS PKWY. W
COLBERTGA3062801/01/2017 01/10/2019
CH040390FRED'S PHARMACY #1831534 BELL CREEK ROAD
HIAWASSEEGA3054601/01/2017 05/10/2018
CH040390FRED'S PHARMACY #1874203 N. MAIN STREET
GREENSBOROGA3064201/01/2017 05/10/2018
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07759 308 SOUTH US HIGHWAY 441
CLAYTONGA3052504/01/2017  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03798 549 N MAIN ST
CORNELIAGA3053104/01/2017  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07782 8895 US HIGHWAY 29 SOUTH
HULLGA3064604/01/2017  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05613 21 NORTH CAROLINA ST.
HARTWELLGA3064301/01/2020  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04518 920 E. ROBERT TOOMBS AVE.
WASHINGTONGA3067301/01/2020  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03777 312 SO. BROAD STREET
MONROEGA3065507/01/2021  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 4164 1680 OLD PENDERGRASS RD.
JEFFERSONGA3054907/01/2021  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03776 232 ELBERT STREET
ELBERTONGA3063507/01/2023  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04555 4044 LEXINGTON RD
ATHENSGA3060507/01/2023  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04389 6 WEST MAY STREET
WINDERGA3068007/01/2023  
CH040390GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04190 959 BIG A ROAD
TOCCOAGA3057704/01/2025  
CH040390HARTWELL RX INCDBA HARTWELL DRUGS 118 ATHENS STREET
HARTWELLGA3064304/01/2016 12/09/2016
CH04039DHARTWELL RX INCDBA HARTWELL DRUGS 118 ATHENS STREET
HARTWELLGA3064304/01/2016 04/01/2016
CH040390LEXINGTON PHARMACIES INC.SKRIP SHOPPE PHARMACY 778 ATHENS RD.
LEXINGTONGA3064805/06/2019  
CH040390LONG'S DEKALB HEALTH PHARMACYAVITA PHARMACY 1045 1428 SCOTT BLVD
DECATURGA3003007/01/2019  
CH040390LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245307/01/2019  
CH040390MADDEN'S PHARMACY INC.101 COLLEGE AVE.
ELBERTONGA3063510/01/2016 07/13/2017
CH040390OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/01/2024  
CH040390OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/01/2024  
CH040390PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/01/2022 10/01/2022
CH040390PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2023  
CH040390PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/01/2023  
CH040390PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2023  
CH040390PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2023  
CH040390RITE AID OF GEORGIA, INC.RITE AID #1753 859 FRANKLIN SPRINGS STREET
ROYSTONGA3066210/01/2013 03/01/2018
CH040390SELF-MED RX CLAYTON PHARMACY100 S MAIN ST PO BOX 686
CLAYTONGA30525-548010/01/2013  
CH040390SKRIP SHOPPE PHARMACY778 ATHENS RD PO BOX 281
LEXINGTONGA30648-306410/01/2013 05/06/2019
CH040390WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2018  
CH040390WAL-MART PHARMACY 10-000330983 HWY 441 SOUTH
COMMERCEGA3052910/01/2018  
CH040390WAL-MART PHARMACY 10-0510400 SHALLOWFORD RD NW
GAINESVILLEGA3050410/01/2018  
CH040390WAL-MART PHARMACY 10-0520440 ALANTA HIGHWAY, N.W.
WINDERGA3068004/01/2014  
CH040390WAL-MART PHARMACY 10-07802050 W SPRING ST
MONROEGA3065507/01/2021  
CH040390WAL-MART PHARMACY 10-11111572 ANDERSON HWY
HARTWELLGA3064310/01/2018  
CH040390WAL-MART PHARMACY 10-11223886 HIGHWAY 17 ALT
EASTANOLLEEGA3053810/01/2018  
CH040390WAL-MART PHARMACY 10-1403250 FURNITURE DRIVE
CORNELIAGA3053110/01/2018  
CH040390WAL-MART PHARMACY 10-1701955 ELBERT STREET
ELBERTONGA3063510/01/2018  
CH040390WAL-MART PHARMACY 10-27531455 HIGHWAY 441 SOUTH
CLAYTONGA3052504/01/2014  
CH040390WAL-MART PHARMACY 10-28114375 LEXINGTON ROAD
ATHENS (E)GA3060510/01/2018  
CH040390WAL-MART PHARMACY 10-4616260 DONALD E THURMOND PARKWAY
CLEVELANDGA3052801/01/2018  
CH040390WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2018  
CH040390WALGREEN CODBA: WALGREENS #11166 18 COLLEGE AVE
ELBERTONGA3063510/18/2011 02/25/2025
CH040390WALGREEN CODBA: WALGREENS #11791 2100 N BROAD STREET
COMMERCEGA3052910/18/2011  
CH040390WALGREEN CO.DBA: WALGREENS # 07134 110 HAWTHORNE AVE
ATHENSGA30606-281410/18/2011  
CH040390WALGREEN CO.DBA: WALGREENS # 09706 472 S ENOTA DR NE
GAINESVILLEGA3050110/18/2011  
CH040390WALGREEN CO.DBA: WALGREENS #12464 355 HIGHWAY 441 S
CLAYTONGA3052510/18/2011  
CH040390WALGREEN CO.DBA: WALGREENS #12726 10 EAST MAY STREET
WINDERGA3068010/18/2011  
CH040390WALGREEN CO.DBA; WALGREENS #12886 3355 LEXINGTON ROAD
ATHENSGA3060510/18/2011 02/21/2024
CH040390WALGREEN CO.DBA: WALGREENS #12502 876 BIG A ROAD
TOCCOAGA3057701/01/2018  
CH040390WALGREEN CO.RITE AID #11827 39 E MAY ST, STE 1
WINDERGA3068003/26/2018 06/25/2018
CH040390WALGREEN CO.WALGREENS #19011 859 FRANKLIN SPRINGS ST
ROYSTONGA3066203/26/2018  
CH040390WALGREEN CO.DBA: WALGREENS #18250 379 N MAIN ST
CLEVELANDGA3052810/01/2018  
CH040390WALGREEN CO.WALGREENS #19561 1235 WASHINGTON ST
CLARKESVILLEGA3052307/01/2020  
CH040390WALGREEN CO.DBA: WALGREENS # 06374 649 SHALLOWFORD RD NW
GAINESVILLEGA3050407/01/2020  
CH040390WALGREEN CO.WALGREENS #17732 380 GENERAL DANIEL AVE N
DANIELSVILLEGA3063307/01/2020  
CH040390WALGREEN CO.WALGREENS #19973 189 QUALITY FOODS SHOPPING CTR
CORNELIAGA30531-578807/01/2020  
CH040390WALGREEN CO.DBA: WALGREENS # 05446 2990 FIVE FORKS TRICKUM RD
LAWRENCEVILLEGA3004401/01/2021  
CH040390WALGREENS OF NORTH CAROLINA INC.DBA: WALGREENS #16105 19 SAWMILL VILLAGE LANE
FRANKLINNC2873401/01/2018  
CH040390WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2022  
CH040390WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2022  
CH040390WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2022  
CH040390WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CH040390Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH040390WILKES APOTHECARYD/B/A: FIEVET PHARMACY 115 E ROBERT TOOMBS AVE
P. O. BOX 626 		WASHINGTONGA30673-173710/01/2013 12/12/2016
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/4/2024 1:16:40 PM2/11/2025 7:50:50 AM2/11/2025 7:50 AM
AddressesMain AddressUpdateChange Request 611 Hospital Rd Commerce, GA 30529-1143 611 Hospital Rd Commerce, GA 305299/3/2024 12:23 PM
DetailsLast Recertification DateUpdateRecertification2/1/2023 8:17:50 AM2/4/2024 1:16:40 PM2/4/2024 1:16 PM
AddressesMain AddressUpdateChange Request 613 Hospital Rd Commerce, GA 30529-1143 611 Hospital Rd Commerce, GA 30529-11434/26/2023 8:55 AM
DetailsEntity SubnameUpdateChange RequestMedLink JacksonMedLink Commerce4/26/2023 8:55 AM
DetailsLast Recertification DateUpdateRecertification2/1/2022 6:56:59 PM2/1/2023 8:17:50 AM2/1/2023 8:17 AM
DetailsLast Recertification DateUpdateRecertification2/6/2021 8:27:32 AM2/1/2022 6:56:59 PM2/1/2022 6:56 PM
Medicaid BillingNPI: StateUpdateRecertification GA2/6/2021 8:27 AM
Medicaid BillingNPI: StateUpdateRecertification GA2/6/2021 8:27 AM
Medicaid BillingNPI: StateUpdateRecertification GA2/6/2021 8:27 AM
DetailsLast Recertification DateUpdateRecertification2/5/2020 7:37:43 AM2/6/2021 8:27:32 AM2/6/2021 8:27 AM
DetailsLast Recertification DateUpdateRecertification1/30/2019 7:56:30 AM2/5/2020 7:37:43 AM2/5/2020 7:37 AM
DetailsLast Recertification DateUpdateRecertification 1/30/2019 7:56:30 AM1/30/2019 7:56 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/12/2018 2:10 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003204487A12/12/2018 2:10 PM
Medicaid BillingMedicaid: StateInsertChange Request GA12/12/2018 2:10 PM
ContactsPrimary ContactUpdate Kimbrell, Dennis Director of Pharmacy Services Medlink Georgia, Inc 7067883234Kimbrell, Dennis Director of Pharmacy Services Medlink Georgia, Inc 7067883234-22049/25/2018 11:40 AM
ContactsPrimary ContactUpdateChange RequestForman, Joey W Strategic Initiative Program Manager MedLink Georgia, Inc 7067883234-1025Kimbrell, Dennis Director of Pharmacy Services Medlink Georgia, Inc 70678832349/25/2018 5:06 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False5/29/2018 8:39 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003167129A5/29/2018 8:39 PM
Medicaid BillingMedicaid: StateInsertChange Request GA5/29/2018 8:39 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False5/29/2018 8:39 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003202598A5/29/2018 8:39 PM
Medicaid BillingMedicaid: StateInsertChange Request GA5/29/2018 8:39 PM
Medicaid BillingNPI: NumberInsertChange Request 12457322545/29/2018 8:39 PM
Medicaid BillingNPI: NumberInsertChange Request 18012627205/29/2018 8:39 PM
Medicaid BillingNPI: NumberInsertChange Request 14770685265/29/2018 8:39 PM
DetailsStateUpdateOPA EditApprovedActive4/13/2018 8:22 AM
DatesStart DateUpdateOPA Edit7/1/2018 12:00:00 AM4/13/2018 12:00:00 AM4/13/2018 8:22 AM
ContactsSigned ByInsertNew Registration Ward, Dave CEO Medlink Georgia, Inc 70678832344/13/2018 8:21 AM
Details340B IDUpdateNew Registration CH04039T4/13/2018 8:21 AM
DatesParticipating Approval DateUpdateNew Registration 4/13/2018 8:21:17 AM4/13/2018 8:21 AM
DetailsStateUpdateNew RegistrationPendingApproved4/13/2018 8:21 AM
DatesSigned By DateUpdateNew Registration 4/12/2018 5:18:52 PM4/13/2018 8:21 AM
DatesStart DateUpdateNew Registration 7/1/2018 12:00:00 AM4/13/2018 8:21 AM
AddressesMain AddressInsertNew Registration  613 Hospital Rd Commerce, GA 30529-11434/12/2018 2:59 PM
ContactsPrimary ContactInsertNew Registration Forman, Joey W Strategic Initiative Program Manager MedLink Georgia, Inc 7067883234-10254/12/2018 2:59 PM
ContactsAuthorizing OfficialInsertNew Registration Ward, Dave CEO Medlink Georgia, Inc 70678832344/12/2018 2:59 PM
DetailsLast Recertification DateInsertNew Registration  4/12/2018 2:59 PM
DetailsGrant NumberInsertNew Registration H80CS004274/12/2018 2:59 PM
Details340B IDInsertNew Registration  4/12/2018 2:59 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/12/2018 2:59 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/12/2018 2:59 PM
DetailsMedicare Provider NumberInsertNew Registration  4/12/2018 2:59 PM
DetailsEntity NameInsertNew Registration Medlink Georgia, Inc4/12/2018 2:59 PM
DetailsProgram CodeInsertNew Registration CH4/12/2018 2:59 PM
DetailsEntity SubnameInsertNew Registration MedLink Jackson4/12/2018 2:59 PM
DatesParticipating Approval DateInsertNew Registration  4/12/2018 2:59 PM
DetailsStateInsertNew Registration Pending4/12/2018 2:59 PM
DatesRegistration DateInsertNew Registration 4/12/2018 2:59:37 PM4/12/2018 2:59 PM
DatesSigned By DateInsertNew Registration  4/12/2018 2:59 PM
DatesStart DateInsertNew Registration  4/12/2018 2:59 PM
TerminationsTermination CommentsInsertNew Registration  4/12/2018 2:59 PM
TerminationsTermination DateInsertNew Registration  4/12/2018 2:59 PM
TerminationsTermination Effective DateInsertNew Registration  4/12/2018 2:59 PM
TerminationsTermination ReasonInsertNew Registration  4/12/2018 2:59 PM