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WOODY'S LONGBRANCH PHARMACY, INC.
CH04211P GEORGIA MOUNTAINS HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Subdivision Name
Fannin County Medical and Admin consolidated site
Type
HRSA-Funded Health Center
340B ID
CH04211P
Entity Address
165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Grant Number
H80CS00093
Participating Start Date
4/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WOODY'S LONGBRANCH PHARMACY, INC.
Pharmacy Address
DBA WOODY'S PHARMACY
130 LONG BRANCH RD
DAHLONEGA, GA 30533
Pharmacy Comments
Contract Details
Approval Date
1/11/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Miracle, CEO
(706) 946-5610
Contract Pharmacy Representative
Woody's Pharmacy
Kevin Woody, Owner
(706) 867-9493
Signed By Date
1/11/2021
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