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KROGER PHARMACY #629
CH047430 GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Subdivision Name
GHMS Cumming Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH047430
Entity Address
260 Elm St
Cumming, GA 30040-2467
Grant Number
H80CS00470
Participating Start Date
1/1/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #629
Pharmacy Address
125 MAIN STREET MARKET PLACE SE
CARTERSVILLE, GA 30121
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Shifflet, CEO
(770) 887-1668 Ext: 1102
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/14/2017
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