Contract Pharmacy Details

WALGREEN CO.
CHC00836-14 South Central Primary Care Center, Inc.

Covered Entity Details

Entity Name

South Central Primary Care Center, Inc.

Subdivision Name

Irwin Family Medicine

Type

HRSA-Funded Health Center

340B ID

CHC00836-14

Entity Address

361 Cargile Rd
Ocilla, GA 31774-3606

Grant Number

H80CS00836

Participating Start Date

10/1/2018

Last Recertification Date

2/4/2021

Entity Termination Date

4/1/2022

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

4/1/2022
Covered Entity Terminated

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