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WALGREEN CO.
CHC00836-15 South Central Primary Care Center, Inc.
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Covered Entity Details
Entity Name
South Central Primary Care Center, Inc.
Subdivision Name
Northside Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC00836-15
Entity Address
247-B Northside Drive
Valdosta, GA 31605
Grant Number
H80CS00836
Participating Start Date
1/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06899
2815 N ASHLEY STREET
VALDOSTA, GA 31602-1806
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
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
1/14/2020
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