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GEORGIA CVS PHARMACY, L.L.C.
STD30236 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Serve Clayton Initiative
Type
Sexually Transmitted Diseases
340B ID
STD30236
Entity Address
1117 Battlecreek Road
Jonesboro, GA 30236
Grant Number
5NH25PS004329-04-00
Participating Start Date
7/1/2020
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02943
842 PEACHTREE STREET, NE
ATLANTA, GA 30308
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jacqueline Brown, Chief Executive Officer
(404) 526-1145
Contract Pharmacy Representative
WellPartner
Anthony McEeachern, Anthony McEachern
(315) 314-1802
Signed By Date
10/11/2021
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