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OCILLA PHARMACY, INC.
CHC00836-05 SOUTH CENTRAL PRIMARY CARE CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL PRIMARY CARE CENTER
Subdivision Name
South Central Primary Care Center, Inc. - Operations Building
Type
HRSA-Funded Health Center
340B ID
CHC00836-05
Entity Address
406 W 5th St
Ocilla, GA 31774-1421
Grant Number
H80CS00836
Participating Start Date
7/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OCILLA PHARMACY, INC.
Pharmacy Address
515 N IRWIN AVE
OCILLA, GA 31774-5007
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Contract Pharmacy Representative
Ocilla Pharmacy, Inc.
John Price, Owner
(229) 468-5929
Signed By Date
4/9/2021
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