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WALGREEN CO.
CHC00836-03 SOUTH CENTRAL PRIMARY CARE CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL PRIMARY CARE CENTER
Subdivision Name
South Central Family Health Care
Type
HRSA-Funded Health Center
340B ID
CHC00836-03
Entity Address
607 C. N. Irwin Ave.
Ocilla, GA 31774-5009
Grant Number
H80CS00836
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19147
162 OCILLA HWY
STE C
FITZGERALD, GA 31750
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/20/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice Presiden, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2018
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