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POSITIVE IMPACT HEALTH CENTERS, INC.
STD30134 DOUGLAS COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
DOUGLAS COUNTY HEALTH DEPARTMENT
Subdivision Name
District 3-1
Type
Sexually Transmitted Diseases
340B ID
STD30134
Entity Address
6770 Selman Drive
DOUGLASVILLE, GA 30134
Grant Number
NH25PS005184
Participating Start Date
1/1/2000
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
POSITIVE IMPACT HEALTH CENTERS, INC.
Pharmacy Address
PIHC PHARMACY
3350 BRECKINRIDGE BLVD STE 200A
DULUTH, GA 30096
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/12/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Latasha Terry, STD Director
(678) 644-5464
Contract Pharmacy Representative
Cobb & Douglas Public Health
Selina Gore Moon, RPH
(770) 514-2345
Signed By Date
1/15/2020
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