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KROGER DRUGSTORE #411
CH04518A COMMUNITY HEALTH CARE SYSTEMS INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CARE SYSTEMS INC
Subdivision Name
TENNILLE COMMUNITY HLTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04518A
Entity Address
116 SMITH ST
TENNILLE, GA 31089-1465
Grant Number
H80CS00507
Participating Start Date
11/28/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER DRUGSTORE #411
Pharmacy Address
4628 PRESIDENTIAL PKWY
MACON, GA 31206
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carla Belcher, CEO
(478) 552-7384 Ext: 1211
Contract Pharmacy Representative
Community Health Care Systems, Inc.
Carla Belcher, CEO
(478) 552-7384 Ext: 1211
Signed By Date
7/15/2020
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