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SOUTHSIDE PHARMACY
CH046900 MEDCURA HEALTH, INC.
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Covered Entity Details
Entity Name
MEDCURA HEALTH, INC.
Subdivision Name
STONE MOUNTAIN
Type
HRSA-Funded Health Center
340B ID
CH046900
Entity Address
5582 MEMORIAL DRIVE
STONE MOUNTAIN, GA 30083
Grant Number
H80CS00179
Participating Start Date
4/1/2004
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
SOUTHSIDE PHARMACY
Pharmacy Address
6330 WEST LOOP S STE 700D
BELLAIRE, TX 77401-2928
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeff Taylor, Chief Executive Officer
(404) 298-3250
Contract Pharmacy Representative
Southside Pharmacy
Roshan Koppuzhayil, Director of Pharmacy Operations
(832) 495-5597
Signed By Date
4/11/2019
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