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HOLMES PHARMACY
TB30263 COWETA COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
COWETA COUNTY HEALTH DEPARTMENT
Subdivision Name
TB CLINIC
Type
Tuberculosis
340B ID
TB30263
Entity Address
70 Hospital Road
NEWNAN, GA 30263
Grant Number
NU52PS910250
Participating Start Date
1/1/2001
Last Recertification Date
5/16/2024
Pharmacy Details
Pharmacy Name
HOLMES PHARMACY
Pharmacy Address
136 COMMERCE AVE
PO BOX 972
LAGRANGE, GA 30241-2338
Pharmacy Comments
Contract Details
Approval Date
10/6/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/17/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROSE-MARIE F SALES, DIRECTOR, TUBERCULOSIS PROGRAM
(404) 657-2597
Contract Pharmacy Representative
Perry Prather, Pharmacist
(706) 884-7301
Signed By Date
10/6/2015
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