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WAL-MART PHARMACY 10-1367
CH0452110 FIRST CHOICE PRIMARY CARE , INC
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Covered Entity Details
Entity Name
FIRST CHOICE PRIMARY CARE , INC
Subdivision Name
FIRST CHOICE PRIMARY CARE INC
Type
HRSA-Funded Health Center
340B ID
CH0452110
Entity Address
770 WALNUT STREET
MACON, GA 31201
Grant Number
H80CS08242
Participating Start Date
10/1/2007
Last Recertification Date
2/2/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1367
Pharmacy Address
2720 WATSON BLVD
WARNER ROBINS, GA 31093
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Katherine McLeod, CEO
(478) 254-7204
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/11/2019
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