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HOLMES PHARMACY
TB30214 FAYETTE COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
FAYETTE COUNTY HEALTH DEPARTMENT
Subdivision Name
TB CLINIC
Type
Tuberculosis
340B ID
TB30214
Entity Address
245 Booker Avenue, STE A
FAYETTEVILLE, GA 30215-1520
Grant Number
NU52PS910250
Participating Start Date
1/1/2001
Last Recertification Date
5/9/2025
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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