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SMITH'S PHARMACY
CH043340 CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Family Practice and Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH043340
Entity Address
510 Alston Street
Suite A
Richland, GA 31825-1404
Grant Number
H80CS00393
Participating Start Date
4/1/2002
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
BAZEMORE, ROBERT JOHNNY PRES
10 N POPLAR ST
P.O. BOX 546
BUTLER, GA 31006
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
Smith's Pharmacy
Robert Baze, Owner
(478) 862-5655
Signed By Date
4/12/2019
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