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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11794
11343 US HIGHWAY 319 N
THOMASVILLE, GA 31757
Pharmacy Comments
Contract Details
Approval Date
1/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANN ADDISON, CEO
(229) 723-2660
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2016
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