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AHSSHC
CH044369A PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH044369A
Entity Address
360 COLLEGE STREET
BLAKELY, GA 39823
Grant Number
H80CS06454
Participating Start Date
12/6/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
AHSSHC
Pharmacy Address
EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ANN ADDISON, CEO
(229) 723-2660
Contract Pharmacy Representative
Agape
Trenia Yielding, Executive Director
(407) 357-2601
Signed By Date
7/14/2014
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