Contract Pharmacy Details

GEORGIA CVS PHARMACY, L.L.C.
CH040490 CURTIS V. COOPER PRIMARY HEALTH CARE, INC.

Covered Entity Details

Entity Name

CURTIS V. COOPER PRIMARY HEALTH CARE, INC.

Subdivision Name

FORMERLY WESTSIDE URBAN HLTH CTRS, INC.

Type

HRSA-Funded Health Center

340B ID

CH040490

Entity Address

106 EAST BROAD STREET
SAVANNAH, GA 31401

Grant Number

H80CS00082

Participating Start Date

12/1/1992

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

GEORGIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07758
410 S. COLUMBIA AVE.
RINCON, GA 31326

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

4/24/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Albert B. Grandy JR., CEO
(912) 527-1117

Contract Pharmacy Representative

Wellpartner
Michael Petryna, National Sales Executive
(720) 377-7745

Signed By Date

4/15/2020

340B Drug Pricing Program Database