Contract Pharmacy Details

M.N. PHARMACY LLC
CHC00836-11 South Central Primary Care Center, Inc.

Covered Entity Details

Entity Name

South Central Primary Care Center, Inc.

Subdivision Name

South Central Primary Care Center - Administrative Building

Type

HRSA-Funded Health Center

340B ID

CHC00836-11

Entity Address

204 E. 4th St.
Ocilla, GA 31774-1539

Grant Number

H80CS00836

Participating Start Date

10/1/2018

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

M.N. PHARMACY LLC

Pharmacy Address

DBA AMAZON PHARMACY #003
6701 NW 7TH ST., STE. #199
MIAMI, FL 33126

Pharmacy Comments

Contract Details

Approval Date

10/12/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robert B. Tucker, CEO
(229) 468-9166 Ext: 1

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

10/12/2018

340B Drug Pricing Program Database