Contract Pharmacy Details

WAL-MART PHARMACY 10-1403
CH040390 MEDLINK GEORGIA, INC.

Covered Entity Details

Entity Name

MEDLINK GEORGIA, INC.

Subdivision Name

Medlink Colbert

Type

HRSA-Funded Health Center

340B ID

CH040390

Entity Address

11 CHARLIE MORRIS RD
COLBERT, GA 30628

Grant Number

H80CS00427

Participating Start Date

7/1/2005

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1403

Pharmacy Address

250 FURNITURE DRIVE
CORNELIA, GA 30531

Pharmacy Comments

Contract Details

Approval Date

7/5/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dave Ward, CEO
(706) 788-3234

Contract Pharmacy Representative

CaptureRx
Elsa Perez Amador, Senior Customer Relationship Manager
(210) 587-3486

Signed By Date

7/5/2018

340B Drug Pricing Program Database