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GEORGIA CVS PHARMACY, L.L.C.
CAH111310-00 MEDICAL CENTER OF PEACH COUNTY
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Covered Entity Details
Entity Name
MEDICAL CENTER OF PEACH COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111310-00
Entity Address
1960 HIGHWAY 247 CONNECTOR
BYRON, GA 31008
Medicare Provider Number
111310
Participating Start Date
10/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16719
2929 WATSON BLVD
WARNER ROBINS, GA 31093
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laura Gentry, CEO
(478) 654-2423
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2022
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