Contract Pharmacy Details

CLINIC DRUG STORE
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

CLINIC DRUG STORE

Pharmacy Address

1001 E FORSYTH ST
PO BOX 445
AMERICUS, GA 31709

Pharmacy Comments

Contract Details

Approval Date

4/6/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ajay Gehlot, CEO
(229) 273-8881

Contract Pharmacy Representative

Lee Pinnell, Owner
(229) 924-2783

Signed By Date

4/6/2017