Contract Pharmacy Details

GEORGIA CVS PHARMACY, L.L.C.
CAH111328-00 Phoebe Worth Medical Center

Covered Entity Details

Entity Name

Phoebe Worth Medical Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH111328-00

Entity Address

807 South Isabella Street
Sylvester, GA 31791-0545

Medicare Provider Number

111328

Participating Start Date

10/1/2011

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

GEORGIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04560
1509 RADIUM SPRINGS
ALBANY, GA 31705

Pharmacy Comments

Contract Details

Approval Date

7/20/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Candace Guarnieri, VP of Finance
(229) 777-3851

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/20/2020

340B Drug Pricing Program Database