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GEORGIA CVS PHARMACY, L.L.C.
STD303037 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Mobile1
Type
Sexually Transmitted Diseases
340B ID
STD303037
Entity Address
230 Peachtree Street NW
Suite 1800
Atlanta, GA 30303-1514
Grant Number
5NH25PS004329-04-00
Participating Start Date
10/1/2019
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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