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WALGREEN CO.
CHC00836-03 SOUTH CENTRAL PRIMARY CARE CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL PRIMARY CARE CENTER
Subdivision Name
South Central Family Health Care
Type
HRSA-Funded Health Center
340B ID
CHC00836-03
Entity Address
607 C. N. Irwin Ave.
Ocilla, GA 31774-5009
Grant Number
H80CS00836
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #18291
402 S DAVIS ST
NASHVILLE, GA 31639
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
1/13/2020
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