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COVENANT HEALTH PHARMACY, INC
RWIID303031 GEORGIA DEPT OF PUBLIC HEALTH
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Covered Entity Details
Entity Name
GEORGIA DEPT OF PUBLIC HEALTH
Subdivision Name
Type
Ryan White Part B ADAP Direct Purchase
340B ID
RWIID303031
Entity Address
200 Piedmont Ave. SE
West Tower
Suite 1508
ATLANTA, GA 30334
Grant Number
X07HA22709
Participating Start Date
4/1/1997
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COVENANT HEALTH PHARMACY, INC
Pharmacy Address
1795 PRESIDENTIAL CIR
SNELLVILLE, GA 30078
Pharmacy Comments
Contract Details
Approval Date
9/24/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marisol Cruz, HIV Care Program Manager
(404) 463-2453
Contract Pharmacy Representative
Covenant Health Pharmacy
Joy Tekobo, CEO
(678) 585-4962
Signed By Date
9/24/2020
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