Contract Pharmacy Details

FLINT RIVER PHARMACY LLC
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

FLINT RIVER PHARMACY LLC

Pharmacy Address

506-C SPAULDING ROAD
MONTEZUMA, GA 31063

Pharmacy Comments

Contract Details

Approval Date

10/9/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/12/2018
Ownership change

Contacts

Covered Entity Signing Official

Ajay Gehlot, CEO
(229) 273-8881

Contract Pharmacy Representative

Ken Rogers, Owner
(478) 472-0111

Signed By Date

10/9/2015