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WAL-MART PHARMACY 10-2753
CH040390 MEDLINK GEORGIA, INC.
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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
WAL-MART PHARMACY 10-2753
Pharmacy Address
1455 HIGHWAY 441 SOUTH
CLAYTON, GA 30525
Pharmacy Comments
Contract Details
Approval Date
1/7/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Ward, CEO
(706) 788-3234
Contract Pharmacy Representative
Marcus Osborne, V.P. Health and Wellness, Sales and Contracting
(479) 204-9374
Signed By Date
1/7/2014
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