Contract Pharmacy Details

PLAINS PHARMACY INC
CH043340 CareConnect Health, Inc.

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

PLAINS PHARMACY INC

Pharmacy Address

103 MAIN STREET .
P.O. BOX 160
PLAINS, GA 31780

Pharmacy Comments

Contract Details

Approval Date

10/1/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ajay Gehlot, CEO
(229) 273-8881

Contract Pharmacy Representative

Julie Scott, Pharmacy Manager
(229) 824-5225

Signed By Date

10/1/2013