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GEORGIA CVS PHARMACY, L.L.C.
CAH111325-00 WILLS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WILLS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111325-00
Entity Address
120 GORDON STREET
WASHINGTON, GA 30673
Medicare Provider Number
111325
Participating Start Date
10/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04556
109 WEST HILL STREET
THOMSON, GA 30824
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/7/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tracie P. Haughey, CEO
(706) 678-9212
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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