Contract Pharmacy Details

GEORGIA CVS PHARMACY, L.L.C.
CH043823A BREVARD HEALTH ALLIANCE INC., THE

Covered Entity Details

Entity Name

BREVARD HEALTH ALLIANCE INC., THE

Subdivision Name

BHA Melbourne Clinic

Type

HRSA-Funded Health Center

340B ID

CH043823A

Entity Address

17 Silver Palm Avenue
Melbourne, FL 32901-3123

Grant Number

H80CS04213

Participating Start Date

4/1/2005

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

GEORGIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07223
807 N. MAIN ST.
LAFAYETTE, GA 30728

Pharmacy Comments

Contract Details

Approval Date

7/13/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/9/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Austin Helton, CEO
(321) 241-6854

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/13/2021

340B Drug Pricing Program Database