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GEORGIA CVS PHARMACY, L.L.C.
CAH111305-00 Hospital Authority of Miller County DBA Miller County Hospital
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Covered Entity Details
Entity Name
Hospital Authority of Miller County DBA Miller County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111305-00
Entity Address
209 N. Cuthbert St
Colquitt, GA 39837
Medicare Provider Number
111305
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04535
817 EAST SHOTWELL ST
BAINBRIDGE, GA 39819
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Rau, CEO
(229) 758-5954
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2020
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