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CHANCY DRUGS MOULTRIE LLC
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
CHANCY DRUGS MOULTRIE LLC
Pharmacy Address
101 N MAIN ST
MOULTRIE, GA 31768
Pharmacy Comments
Contract Details
Approval Date
7/22/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
Chancy Drugs
Corey Mackie, 340B Manager
(229) 985-6725
Signed By Date
7/22/2019
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