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WAL-MART PHARMACY 10-3874
CH047430 GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Subdivision Name
GHMS Cumming Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH047430
Entity Address
260 Elm St
Cumming, GA 30040-2467
Grant Number
H80CS00470
Participating Start Date
1/1/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3874
Pharmacy Address
98 POWER CENTER DR
DAWSONVILLE, GA 30534
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/24/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Todd Shifflet, CEO
(770) 887-1668 Ext: 1102
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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