Contract Pharmacy Details

SELF-MED RX CLAYTON PHARMACY
CH040390 MEDLINK GEORGIA, INC.

Covered Entity Details

Entity Name

MEDLINK GEORGIA, INC.

Subdivision Name

Medlink Colbert

Type

HRSA-Funded Health Center

340B ID

CH040390

Entity Address

11 CHARLIE MORRIS RD
COLBERT, GA 30628

Grant Number

H80CS00427

Participating Start Date

7/1/2005

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

SELF-MED RX CLAYTON PHARMACY

Pharmacy Address

100 S MAIN ST
PO BOX 686
CLAYTON, GA 30525-5480

Pharmacy Comments

Contract Details

Approval Date

7/8/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dave Ward, CEO
(706) 788-3234

Contract Pharmacy Representative

Mike Addington, Owner/Rph
(706) 782-3211

Signed By Date

7/8/2013

340B Drug Pricing Program Database