Contract Pharmacy Details

FRED'S PHARMACY #1874
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

FRED'S PHARMACY #1874

Pharmacy Address

203 N. MAIN STREET
GREENSBORO, GA 30642

Pharmacy Comments

Contract Details

Approval Date

10/16/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/10/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Dave Ward, CEO
(706) 788-3234

Contract Pharmacy Representative

Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346

Signed By Date

10/16/2016

340B Drug Pricing Program Database