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GEORGIA CVS PHARMACY, L.L.C.
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
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04267
214 EAST 16TH AVE.
CORDELE, GA 31015
Pharmacy Comments
Contract Details
Approval Date
4/1/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
4/1/2016
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