Contract Pharmacy Details

WALGREEN CO.
CHC00836-04 SOUTH CENTRAL PRIMARY CARE CENTER

Covered Entity Details

Entity Name

SOUTH CENTRAL PRIMARY CARE CENTER

Subdivision Name

Kid's Health

Type

HRSA-Funded Health Center

340B ID

CHC00836-04

Entity Address

119 Norman Dorminy Drive, Suite A
Fitzgerald, GA 31750-8855

Grant Number

H80CS00836

Participating Start Date

7/1/2014

Last Recertification Date

1/29/2024

Entity Termination Date

10/1/2024

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 Co
Christina Hess, 340B Client Relationships
(847) 964-4000

Signed By Date

7/10/2018

340B Drug Pricing Program Database