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WAL-MART PHARMACY #10-6998
CH040400 Southside Medical Center, Inc.
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Covered Entity Details
Entity Name
Southside Medical Center, Inc.
Subdivision Name
SOUTHSIDE MEDICAL CENTER - Main Center / Corporate HQ
Type
HRSA-Funded Health Center
340B ID
CH040400
Entity Address
1046 Ridge Ave SW
Atlanta, GA 30315-1640
Grant Number
H80CS00576
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-6998
Pharmacy Address
844 CLEVELAND AVENUE
EAST POINT, GA 30344
Pharmacy Comments
Contract Details
Approval Date
10/23/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID M. WILLIAMS, CEO
(404) 564-7030
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/23/2015
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