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WALGREEN CO.
CHC00836-08 SOUTH CENTRAL PRIMARY CARE CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL PRIMARY CARE CENTER
Subdivision Name
South Central Women's Health
Type
HRSA-Funded Health Center
340B ID
CHC00836-08
Entity Address
119 Norman Dorminy Dr. Suite B
Fitzgerald, GA 31750-8855
Grant Number
H80CS00836
Participating Start Date
4/1/2015
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
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